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Pregnancy at 40 years Old and Above: Obstetrical, Fetal, and Neonatal Outcomes. Is Age an Independent Risk Factor for Those Complications?

ABSTRACT: Objectives: Maternal age has been increasing for several decades with many of these late pregnancies between 40 and 45 years old. The main objective of this study is to assess whether maternal age is an independent factor of obstetric, fetal, and neonatal complications.Patients and methods: A monocentric, French study “exposed-unexposed” was conducted during 11 years in a maternity level IIB. Maternal and perinatal outcomes were studied using univariates and multivariate analysis. We compared women aged 40 and above in a 1:1 ratio with women of 25–35 years old.Results: One thousand nine hundred eighty-two women were 40 or older (mean age: 41.9) on the day of their delivery and compared to other 1,982 women who were aged between 25 and 35 years old (mean age: 30.7) Preeclampsia, gestational diabetes, were significantly higher in the study group (4.6 vs. 1.5% and 14.5 vs. 6.9%, respectively, p < 0.001). We found also a significant difference for gestational hypertension (3.1 vs. 1.1% p < 0.001), preterm birth (10.4 vs. 6.5% p < 0.001), cesarean (16.6 vs. 5.4% for scheduled cesarean, and 50.4 vs. 13.9% for emergency cesarean, p < 0.001) and fetal death in utero (2.1 vs. 0.5% in the study group, p < 0.001). These results were also significantly different in multivariate analysis.Conclusion: A pregnancy after 40 years old is worth considering today as far as the risk factors are controlled and understand by the patient and the obstetrician. However, they have a significantly higher risks of cesarean, preterm delivery, pre-eclampsia, gestational diabetes, and fetal death in utero (FDIU). It is therefore the responsibility of the obstetrician to inform correctly these women in a detailed way, to reassure them and to adapt the monitoring of their pregnancy accordingly.

SUBMITTER: Bouzaglou A

PROVIDER: S-EPMC7266997 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Project description:ObjectivesTo estimate the incidence and risk of complications associated with a fetal scalp electrode and to determine whether its application in the setting of operative vaginal delivery was associated with increased neonatal morbidity.DesignRetrospective cohort study.SettingTwelve clinical centers with 19 hospitals across nine American Congress of Obstetricians and Gynecologists US districts.PopulationWomen in the USA.MethodsWe evaluated 171 698 women with singleton deliveries ≥ 23 weeks of gestation in a secondary analysis of the Consortium on Safe Labor study between 2002 and 2008, after excluding conditions that precluded fetal scalp electrode application such as prelabour caesarean delivery. Secondary analysis limited to operative vaginal deliveries ≥ 34 weeks of gestation was also performed.Main outcome measuresIncidences and adjusted odds ratios with 95% confidence intervals of neonatal complications were calculated, controlling for maternal characteristics, delivery mode and pregnancy complications.ResultsFetal scalp electrode was used in 37 492 (22%) of deliveries. In non-operative vaginal delivery, fetal scalp electrode was associated with increased risk of injury to scalp due to birth trauma (1.2% versus 0.9%; adjusted odds ratios 1.62; 95% confidence intervals 1.41-1.86) and cephalohaematoma (1.0% versus 0.9%; adjusted odds ratios 1.57; 95% confidence intervals 1.36-1.83). Neonatal complications were not significantly different comparing fetal scalp electrode with vacuum-assisted vaginal delivery and vacuum-assisted vaginal delivery alone or comparing fetal scalp electrode with forceps-assisted vaginal delivery and forceps-assisted vaginal delivery alone.ConclusionsWe found increased neonatal morbidity with fetal scalp electrode though the absolute risk was very low. It is possible that these findings reflect an underlying indication for its use. Our findings support the use of fetal scalp electrodes when clinically indicated.Tweetable abstractNeonatal risks associated with fetal scalp electrode use were low (injury to scalp 1.2% and cephalohaematoma 1.0%).

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Pregnancy at 40 years Old and Above: Obstetrical, Fetal, and Neonatal Outcomes. Is Age an Independent Risk Factor for Those Complications?

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