Outcome of singleton pregnancy in women >= 45 years old: a retrospective cohort study

Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University , Tel Aviv , Israel.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians (Impact Factor: 1.21). 04/2012; 25(11):2190-3. DOI: 10.3109/14767058.2012.684108
Source: PubMed

ABSTRACT Objective: To investigate prematurity rate in women aged ≥45 carrying a singleton pregnancy. Other maternal and neonatal outcomes are also described. Design: Retrospective cohort study. Setting: Women delivering a singleton pregnancy at a single tertiary medical center. Population: The study included all women aged 45 years and over who delivered at 20 weeks gestation or beyond over a 9-year period from May 2000 to May 2009. Methods: Women aged 45 years and over were identified. The study group was compared to a control group of women <40 years with singleton pregnancies conceived by in vitro fertilization (IVF) who delivered during the same time period. Main Outcome Measure(s): Maternal complications during pregnancy and neonatal outcome. Results: During the study period 278 women ≥45 years delivered a singleton pregnancy. The control group included 304 women. The rate of delivery before 37 weeks as well as before 32 weeks were very high in our study group (18.7 vs. 10.9%, p = 0.009 and 5.4 vs. 2.0%, p = 0.04, respectively). In multivariate analysis, older maternal age was not independently related to prematurity. Chronic hypertension (HTN) was found to be a major risk factor associated with prematurity in advanced maternal age. Conclusions: Women ≥45-years-old with a singleton pregnancy carry a higher risk of maternal and perinatal complications. Preterm birth is a significant complication in this age group and is associated with preexisting chronic HTN.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Aim: Delivering after the age of 40 years can be challenging. Worldwide, compared to previous decade, the number of deliveries in this particular category of age is increasing constantly. The goal of the present study was to analyze the outcome of vaginal delivery in this category of patients. Materials and methods: A retrospective study was performed in The First Clinic of Obstetrics and Gynecology, Cluj-Napoca, Romania between 1st of January 2012 and 31st of December 2012. All deliveries that took place in the above mentioned hospital in the mentioned period were included in the study. Results: A significant increased number of Cesarean sections were observed in the group of older patients. The duration of the active phase was shorter in ≥40 years old primiparas than in <40 years old primiparas and similar to younger patient group for parity ≥2. The Apgar score and the fetal weight were not influenced by the maternal age. Regardless of parity, the frequency of the episiotomy practice was similar in women ≥40 years old and <40 years old. Conclusion: Vaginal delivery is still a valid option for women 40 or older. A retrospective analysis of all births that took place in the 1st Clinic of Obstetrics and Gynecology, Emergency County Hospital, Cluj-Napoca, Romania (a university teaching hospital) during 12 months (year 2012) was performed. 1,872 patients were included in the study. The multiple pregnancies (84 patients) were excluded from further analysis. All patients with breech presentation or transverse lie delivered by cesarean section (CS) were excluded from the vaginal birth analysis. For statistical purposes, based on the age at delivery, the patients were divided in two groups: <40 years old (n=1744) and ≥40 years old (n=45). For each patient, the following parameters were collected: age, gravidity, parity, delivery route, neonatal parameters (weight, Apgar score, sex). In patients who delivered vaginally, the following supplementary parameters were analyzed: duration of dilatation period, duration of expulsion, duration and type of expulsion, use of episiotomy, vaginal or cervical laceration. The data were included in a Microsoft Excel 2007 file and later analyzed using STATA Intercooled 10 (Stata Corp, College Station, Texas). Student's t-test and chi-square test were used where appropriate for comparing the parameters in the different patient groups. A p-value of <0.05 was considered statistically significant. Results and Discussion The present analysis focused on all singleton deliveries (n=1,744). Maternal age The average age in the study group was 29.90 years (SD: 4.80); the youngest patient was 13 years old and the oldest was 45 years old Abbreviations VD:
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: ABSTRACT Aim: Age at delivery has increased in the past decades, leading to a continuous growth of the number of women planning a pregnancy after the age of forty. Because delivering after this age is associated with an increased rate of maternal complications, the objective of this study was to analyze the delivery related issues in women >=40 years of age. Materials and methods: This was a retrospective study conducted in the 1st Clinic of Obstetrics and Gynecology, Cluj- Napoca in a 3-year period. One hundred and forty-two patients >=40 years of age that delivered between 2010 and 2012 were included in the analysis. Results: The frequency of deliveries after the age of 40 was 2.42% of all the deliveries. Eighty percent of nulliparous and 51.72% of multiparous women delivered by cesarean section. A significantly higher percentage of primiparous women delivered by cesarean section compared to secundiparous women (p = 0.0007). Fetal weight was significantly higher in multiparous than in primiparous women in the CS group (p = 0.01). No differences were observed between the Apgar scores according to the delivery mode or parity in the study group. Conclusion: Delivery after 40 years of age is associated with an increased number of obstetrical interventions.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose Delayed childbearing is increasingly common; hence, concerns emerge regarding potential for additional risks of delivery at advanced maternal age (AMA; ≥35 years). In this study, we sought to assess impact of AMA and parity on maternal and perinatal outcomes. Methods In this retrospective single-center study (July 2005 to October 2011), we compared spontaneously-conceived singleton births of AMA mothers with spontaneously-conceived singletons of mothers aged 24–27 years. Maternal outcomes: incidence of diabetes, hypertension, and emergency cesarean sections (ECS). Neonatal outcomes: prematurity, birth weight, incidence of small or large for gestational age infants (SGA/LGA, respectively), low birth weight (LBW), and 5′-Apgar scores. Sub-groupings of maternal age were 35–38, 39–42, or 43–47 years; prematurity as Results Of 24,579 eligible women, 11,243 were AMA (14.0 % total singleton births) and 13,336 were aged 24–27 years (16.7 % total singleton births) at delivery. There were no maternal or perinatal deaths. Incidence of maternal hypertension and diabetes was significantly greater in AMA, especially oldest AMA. AMA including primiparous had significantly more ECS than younger including primiparous controls, respectively, and were more likely to deliver LGA neonates. Primiparous AMA women did not have increased incidence of LGA babies but significantly increased incidence of SGA infants. Conclusion AMA, especially primiparous, has more adverse maternal and neonatal outcomes than younger women; however, these did not include mortality. Consistent antenatal care may explain this.
    Archives of Gynecology and Obstetrics 09/2014; 291(4). DOI:10.1007/s00404-014-3469-0 · 1.28 Impact Factor

Full-text (2 Sources)

Available from
Nov 11, 2014