Do Primiparas Aged 40 Years or Older Carry an Increased Obstetric Risk?

Scholz, Heinz S.; Haas, Josef; Petru, Edgar

doi:10.1006/pmed.1999.0536

Cited by 35 publications

(27 citation statements)

References 8 publications

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“…Culturally, smoking is uncommon among Jordanian women. This study confirms that women of maternal age 35 years and older are at high risk of preterm birth, small for gestational age infants, and low birth weight [3,[12][13][14][15][16]. The course of labour and delivery was also different in the older nulliparous women.…”

Section: Discussionsupporting

confidence: 70%

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Maternal and Perinatal Outcome in Nulliparous Women Aged 35 and Older

Ziadeh¹

2002

Gynecol Obstet Invest

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Objective: To compare the maternal and perinatal outcome of nulliparous women 35 years and older at the time of delivery with nulliparous women 25–29 years old. Methods: A retrospective review of maternal and newborn records of singleton gestations only for first birth in women aged 35 and older (study group n = 143) were compared with pregnancies of women aged 25–29 (control group, n = 148) delivered at the same period with respect to pregnancy complications and outcome. The study was performed at the Princess Badeea Teaching Hospital in North Jordan between January 1, 1996 and July 1, 2000. Results: Most of the elderly nulliparous women were professionals (60%) and 20% had a history of infertility. Compared with women aged 20–29 years, women delivering their first child at or >35 years were at increased risk of weight gain, obesity, chronic and pregnancy-induced hypertension, antepartum haemorrhage, multiple gestation, malpresentation, and premature rupture of membranes. Women aged 35 years and older were also substantially more likely to have preterm labour, oxytocin use, and caesarean births. The older women differed significantly in neonatal outcomes: gestational age, birth weight, preterm delivery, low birth weight, small for gestational age, fetal distress and neonatal intensive care unit admissions. Conclusion: It is concluded that nulliparous women 35 years and older had higher risk of antepartum, intrapartum, and neonatal complications than nulliparous women aged 25–29 years, but these risks, for the most part, are manageable in the context of modern obstetrics. The excess rate of caesarean sections is only partially accounted for by gestational complications. Despite the increased risk of complications, perinatal death of the study group was similar to that of the control group. There were no maternal deaths.

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Section: Discussionsupporting

confidence: 70%

“…0.001). This has been reported by other studies [13,16,17]. The significantly increased operative delivery risk may be explained largely by the antepartum or intra-Ziadeh partum complications.…”

Section: Discussionsupporting

confidence: 60%

Maternal and Perinatal Outcome in Nulliparous Women Aged 35 and Older

Ziadeh¹

2002

Gynecol Obstet Invest

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“…23 Nesse contexto, os resultados do presente estudo, mostrando uma tendência crescente nas taxas de cesariana entre mães com nível socioeconômico mais baixo, teoricamente com maior risco obstétrico, tornam o quadro ainda mais preocupamente. As altas taxas encontradas entre as mulheres de idade igual ou superior a 35 anos, quando comparadas às adolescentes, concorda com resultados de outros estudos 10,24,25 que apontam "gestação tardia" como fator associado à cesariana. Ainda, uma maior prevalência do procedimento entre mães de recém-nascidos prematuros aponta para a ocorrência de "casualidade reversa", onde a utilização excessiva da cesariana como cirurgia eletiva estaria levando a maiores índices de prematuridade e não vice-versa, também relatado em estudo semelhante conduzido no Rio Grande do Sul.…”

Section: Discussionunclassified

Equidade inversa e desigualdades no acesso à tecnologia no parto em Santa Catarina, Brasil, 2000 a 2004

Souza

Kunkel

Gomes

et al. 2007

Rev. Bras. Saude Mater. Infant.

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OBJETIVOS: investigar a evolução temporal das taxas de cesariana e fatores associados em Santa Catarina, no período de 2000 a 2004. MÉTODOS: foram utilizados dados do Sistema de Informações de Nascidos Vivos. As variáveis analisadas foram: escolaridade, idade materna, etnia/cor da pele do recém-nascido, duração da gestação e número de consultas pré-natal. Razões de prevalência de cesariana, brutas e ajustadas para confundimento, foram estimadas para cada uma das variáveis utilizando Regressão de Poisson. RESULTADOS: as taxas encontradas para o período foram o triplo daquelas preconizadas pela Organização Mundial de Saúde e aumentaram de 43,3% em 2000 para 50,6% em 2004. Para todo o período razões de prevalência brutas e ajustadas mostraram-se positivamente associadas ao mais alto grau de escolaridade (R Paj=1,50; IC95%: 1,47-1,52), idade mais elevada (R Paj=2,10; IC95%: 2,05-2,15), maior freqüência ao pré-natal (RPaj=1,27; IC95%: 1,26-1,29), partos pré-termo (RPaj=1,10; IC95%: 1,06-1,13) e pós-termo (RPaj=1,22; IC95%: 1,14-1,30) e proteção para as etnias "indígena" (RPaj=0,79; IC95%: 0,75-0,85) e "não branca" (RPaj=1,10; IC95%: 1,06-1,14). Uma diminuição significante nas RPs ajustadas ao comparar os extremos do período (2000 e 2004) apareceu para quase todas as categorias estudadas. CONCLUSÕES: as taxas de cesariana encontradas estão bem acima daquelas justificando indicações estritamente médicas. Uma diminuição nas RPs ao comparar os extremos do período nos remete a uma redução temporal nos efeitos da "equidade inversa", provável reflexo de um maior acesso à tecnologia no parto entre as camadas de menor padrão socioeconômico, pelo menos em parte atribuível a uma maior liberalidade da prática obstétrica, incluindo uma ampliação das indicações médicas.

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“…Pregnancy, especially first pregnancy, in the age group over 40 may bear an increased risk of complications both for the mother and the newborn [28][29][30][31][32][33][34][35][36][37]. Especially the probability of occurrence of pre-eclampsia, preterm birth and perinatal death seems to be clearly raised.…”

Section: Assessment Of Age Limits For Artmentioning

confidence: 99%

Female Age in ART: When to Stop?

Broekmans¹,

Klinkert²

2004

Gynecol Obstet Invest

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With increasing age the probability of ongoing pregnancy established by the use of assisted reproduction technology (ART) decreases. As a result the question arises whether age limits for the application of ART should be established. From a literature review and ongoing research data it appears that the costs per child born greatly increase after the age of 40 for both intrauterine insemination with mild ovarian stimulation and in vitro fertilisation treatment, while in cases of 44 and over, prognosis is flat zero. The willingness to pay for extra costs will greatly determine whether and at what age strict limits should be applied. Fortunately, predictive factors for success, like the antral follicle count, may enable the identification of women over 40 and under 44 that still have favourable prospects, thereby decreasing the necessary costs per childbirth and allowing couples into ART programs that are often denied based solely on female age.

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Do Primiparas Aged 40 Years or Older Carry an Increased Obstetric Risk?

Cited by 35 publications

References 8 publications

Maternal and Perinatal Outcome in Nulliparous Women Aged 35 and Older

Maternal and Perinatal Outcome in Nulliparous Women Aged 35 and Older

Equidade inversa e desigualdades no acesso à tecnologia no parto em Santa Catarina, Brasil, 2000 a 2004

Female Age in ART: When to Stop?

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