Effect of maternal age on maternal and perinatal outcomes including cesarean delivery following induction of labor in uncomplicated elderly primigravidae

Abstract

Age above 35 years at the time of birth is generally referred to as advanced maternal age (AMA), and it could be a risk factor for various complications besides genetic changes in the fetus. The primary outcome of this study was to determine if AMA is associated with emergent cesarean delivery (CD) following induction of labor (IOL). The secondary outcomes were a composite of adverse maternal and perinatal outcomes following IOL.This retrospective observational study included women with singleton, live-born, cephalic, non-anomalous pregnancies undergoing IOL from 38 0/7 to 41 6/7 weeks of gestation. Mode of delivery and other maternal and neonatal outcomes were compared between women aged ≥35 (AMA) and <35 years. Multivariate logistic regression analyses were performed.A total of 307 nulliparous women underwent IOL (≥35 years n = 73, 23.8%; <35 years n = 234, 76.2%) and among them, 252 (82.1%) delivered vaginally. The rate of CD was significantly higher in women of AMA (31.5% vs 13.7%, P = .001). Multivariable analysis showed that AMA was independently associated with CD (odds ratio 3.04, 95% confidence interval 1.55–5.96, P = .001). The rate of instrumental deliveries was higher in the AMA group (19.6% vs 8.2%, P = .043) and hemoglobin decrease during delivery was similar between the 2 groups (1.90 ± 1.25 vs 2.02 ± 1.27 mg/dL, all P > .05). Regarding neonatal outcomes, there was no difference between the 2 groups in the neonatal intensive care unit admission rate and Apgar score <7 at 5 minutes (30.3% vs 30.1% and 6.0% vs 8.2%, respectively, all P > .05). Neonatal intubation rate and severe respiratory problems were non-significantly higher in AMA (3.8% vs 2.7% and 3.4% vs 1.4%, respectively, all P > .05).AMA was associated with an approximately three-fold increased likelihood of birth by CD and operative vaginal delivery in uncomplicated nulliparous women following IOL. However, we found no evidence that IOL in primigravid women of AMA increases adverse maternal and perinatal outcomes as compared with women aged <35 years except the high prevalence of CD and operative vaginal delivery.

Pregnancy Outcome in Advanced Maternal Age in Comparison With Younger Pregnant Women – A Comparative Study in Central Referral Hospital, Gangtok, Sikkim

“…When controlled for confounders, AMA was independently associated with a two-fold increase in birth by CS following IOL There were no differences in neonatal outcomes. Similar increased incidence of cesarean sections among AMA pregnancies have also been reported by the authors such as Davey et al [12] and Jeong et al [13].…”

The success rate of induction of labour in twin pregnancies compared to singleton : A retrospective matched case-control single-centre study

“…Each twin pregnancy patient undergoing induction of labour was matched with a singleton pregnancy in a 1:1 ratio at the same hospital and during the same study period. Matching was based on specific criteria, including parity (nulliparous or multiparous) 16 , maternal age (advanced maternal age of 35 years or older or not) 16,17 , and indication for induction of labour 18 . These factors were chosen to minimise the confounding factors affecting the success rate of induction of labour.…”

Age and Parity as Risk Factors for Childbirth Complications: A Systematic Review

“…Dengan hasil uji statistik diperoleh hasil p= 0,039 oleh (Mutia et al, 2016). Penelitian lain yang dilakukan di negara lain di asia juga melaporkan hasil yang serupa, seperti pada penelitian Jeong, dkk pada tahun 2021, Xie, dkk pada tahun 2021, Luo, dkk pada tahun 2020, dan Deng, dkk pada tahun 2021 (Jeong et al, 2021;Xie et al, 2021;Luo et al, 2020;Deng et al, 2021).…”