BackgroundMaternal age at pregnancy is increasing worldwide as well as preterm birth. However, the association between prematurity and advanced maternal age remains controversial.ObjectiveTo evaluate the impact of maternal age on the occurrence of preterm birth after controlling for multiple known confounders in a large birth cohort.Study designRetrospective cohort study using data from the QUARISMA study, a large Canadian randomized controlled trial, which collected data from 184,000 births in 32 hospitals. Inclusion criteria were maternal age over 20 years. Exclusion criteria were multiple pregnancy, fetal malformation and intra-uterine fetal death. Five maternal age categories were defined and compared for maternal characteristics, gestational and obstetric complications, and risk factors for prematurity. Risk factors for preterm birth <37 weeks, either spontaneous or iatrogenic, were evaluated for different age groups using multivariate logistic regression.Results165,282 births were included in the study. Chronic hypertension, assisted reproduction techniques, pre-gestational diabetes, invasive procedure in pregnancy, gestational diabetes and placenta praevia were linearly associated with increasing maternal age whereas hypertensive disorders of pregnancy followed a “U” shaped distribution according to maternal age. Crude rates of preterm birth before 37 weeks followed a “U” shaped curve with a nadir at 5.7% for the group of 30–34 years. In multivariate analysis, the adjusted odds ratio (aOR) of prematurity stratified by age group followed a “U” shaped distribution with an aOR of 1.08 (95%CI; 1.01–1.15) for 20–24 years, and 1.20 (95% CI; 1.06–1.36) for 40 years and older. Confounders found to have the greatest impact were placenta praevia, hypertensive complications, and maternal medical history.ConclusionEven after adjustment for confounders, advanced maternal age (40 years and over) was associated with preterm birth. A maternal age of 30–34 years was associated with the lowest risk of prematurity.

BackgroundMaternal age at pregnancy is increasing worldwide as well as preterm birth. However, the association between prematurity and advanced maternal age remains controversial. ObjectiveTo evaluate the impact of maternal age on the occurrence of preterm birth after controlling for multiple known confounders in a large birth cohort. Study designRetrospective cohort study using data from the QUARISMA study, a large Canadian randomized controlled trial, which collected data from 184,000 births in 32 hospitals. Inclusion criteria were maternal age over 20 years. Exclusion criteria were multiple pregnancy, fetal malformation and intra-uterine fetal death. Five maternal age categories were defined and compared for maternal characteristics, gestational and obstetric complications, and risk factors for prematurity. Risk factors for preterm birth <37 weeks, either spontaneous or iatrogenic, were evaluated for different age groups using multivariate logistic regression. Results165,282 births were included in the study. Chronic hypertension, assisted reproduction techniques, pre-gestational diabetes, invasive procedure in pregnancy, gestational diabetes and placenta praevia were linearly associated with increasing maternal age whereas hypertensive disorders of pregnancy followed a "U" shaped distribution according to maternal age. Crude rates of preterm birth before 37 weeks followed a "U" shaped curve with a nadir at 5.7% for the group of 30-34 years. In multivariate analysis, the adjusted odds ratio (aOR) of prematurity stratified by age group followed a "U" shaped distribution with an aOR of 1.08 (95%CI; 1.01-1.15) for 20-24 years, and 1.20 (95% CI; 1.06-1.36) for 40 years and older.

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A 35 year old woman presented with acute abdominal pain located on the left side of the uterus at 23 weeks 6/7. Her obstetrical past is remarkable for G1 = vaginal delivery at term with manual removal of the placenta in the left horn; G2 = spontaneous uterine rupture not far from the left horn at 35 weeks with fetal death; G3 and G4 = miscarriage of a twin and singleton pregnancies respectively with D & C in the latter. Before allowing this current pregnancy, the integrity of the uterine wall was ascertained. A diagnosis of uterine rupture was confirmed as one fetal foot could be seen through the scar with amniotic sac protrusion. An emergent laparotomy was performed. The decision to proceed to an immediate closure of the uterine wall was based on the following: 1) an alive baby, still in the uterine cavity, 2) a posterior placenta, 3) absence of intraperitoneal hemorrhage. During the closure of the uterine wall (6 cm) with vicryl-0, a perfusion of nitroglycerine and phenylephrine were required simultaneously to decrease the intra-amniotic pressure and maintain normal maternal hemodynamics. Unfortunately, the membranes were inadvertently ruptured by the needle of the suture at time of closure. In the postoperative course, the patient received Betamethasone for lung maturity, MgSO 4 for fetal neuroprotection, antibiotics were added for 7 days. Uterine relaxation was obtained with Nifedipine XL 30 mg twice daily until delivery. The thickness of the uterine scar was verified daily with ultrasound. The patient finally underwent an emergent Caesarean section for fetal bradycardia at 27 weeks. A little girl of 970 g is born with an Apgar score of 8.9.9. The scar was still intact. This is the first case never reported of uterine rupture with an immediate closure of the defect in a attempt to prolong the pregnancy. Such management should be considered in presence of an alive premature fetus, still located in the uterine cavity and absence of massive intraperitoneal hemorrhage. P07.12Uterine artery pseudoaneurysm in secondary postpartum hemorrhage: diagnosis with real-time and pulsed Doppler ultrasound