Impact of maternal age on intrapartum caesarean delivery rate in nulliparas with spontaneous labour

Créquit, Simon; Korb, Diane; Schmitz, Thomas; Morin, Cécile; Sibony, Olivier

doi:10.1016/j.jogoh.2019.02.008

Cited by 3 publications

(5 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Neonatal mortality occurred only once in the AMA group, and not in the VAMA group ( p = 0.997). When delivery started spontaneously in both the AMA and VAMA groups, the rate of spontaneous deliveries in attempted vaginal deliveries was 65.6%, in line with an earlier cohort in the USA and a study from France who also included VAMA for analysis 7,16 . Diabetes was two to almost three times higher in prevalence in our cohort than reported in earlier studies 3,26 .…”

Section: Discussionsupporting

confidence: 89%

“…Diabetes was two to almost three times higher in prevalence in our cohort than reported in earlier studies 3,26 . Contradictory to earlier findings, 10,12 but in line with a large population‐based cohort from the USA and a French study, 6,16 adverse outcomes such as preeclampsia and postpartum hemorrhage did not significantly increase with age. This might be an effect of prophylaxis through aspirin and active management of the third stage of labor, as recommended in Dutch Perinatology guidelines 27 .…”

Section: Discussionsupporting

confidence: 86%

“…When delivery started spontaneously in both the AMA and VAMA groups, the rate of spontaneous deliveries in attempted vaginal deliveries was 65.6%, in line with an earlier cohort in the USA and a study from France who also included VAMA for analysis. 7 , 16 Diabetes was two to almost three times higher in prevalence in our cohort than reported in earlier studies. 3 , 26 Contradictory to earlier findings, 10 , 12 but in line with a large population‐based cohort from the USA and a French study, 6 , 16 adverse outcomes such as preeclampsia and postpartum hemorrhage did not significantly increase with age.…”

Section: Discussioncontrasting

confidence: 62%

“…Due to contradictory results and heterogeneous populations from various studies it is not yet clear which factors are correlated with planned and unplanned cesarean sections. It has been proposed that the higher risk of cesarean section was related to the high rate of comorbidities and pregnancy complications reported for advanced maternal age or possibly it was reflective of perceived higher risk by both patients and physicians 15,16 . There are contradictory reports regarding parity, as some reported a more favorable outcome in multiparous women, 3,6,17 where other studies found no clear association between parity and cesarean section, or even found multiparity to be a risk factor for cesarean delivery 7 .…”

Section: Introductionmentioning

confidence: 99%

“…It has been proposed that the higher risk of cesarean section was related to the high rate of comorbidities and pregnancy complications reported for advanced maternal age or possibly it was reflective of perceived higher risk by both patients and physicians. 15 , 16 There are contradictory reports regarding parity, as some reported a more favorable outcome in multiparous women, 3 , 6 , 17 where other studies found no clear association between parity and cesarean section, or even found multiparity to be a risk factor for cesarean delivery. 7 Other hypotheses involve direct effects of aging, such as abnormal uterine implantation and aging myometrium or use of anesthesia during vaginal delivery.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Unplanned cesarean sections in advanced maternal age: A predictive model

Veenstra,

Cohen,

Korteweg

et al. 2024

Acta Obstet Gynecol Scand

View full text Add to dashboard Cite

IntroductionAs maternal age during pregnancy is rising all over the world, there is a growing need for prognostic factors that determine maternal and perinatal outcomes in older women.Material and methodsThis study is a retrospective cohort study of women aged 40 years or older at the time of delivery in four Santeon hospitals across the Netherlands between January 2016 and December 2019. Outcomes were compared between women of 40–44 years (advanced maternal age) and 45 years and older (very advanced maternal age). Primary outcome was unplanned cesarean section, secondary outcomes included postpartum hemorrhage and neonatal outcomes. Multivariate regression analysis was performed to analyze predictive factors for unplanned cesarean sections in women who attempted vaginal delivery. Subsequently, a predictive model and risk scores were constructed to predict unplanned cesarean section.ResultsA cohort of 1660 women was analyzed; mean maternal age was 41.4 years, 4.8% of the women were 45 years and older. In both groups, more than half of the women had not delivered vaginally before. Unplanned cesarean sections were performed in 21.1% of the deliveries in advanced maternal age and in 29.1% in very advanced maternal age. Four predictive factors were significantly correlated with unplanned cesarean sections: higher body mass index (BMI), no previous vaginal delivery, spontaneous start of delivery and number of days needed for cervical priming. A predictive model was constructed from these factors with an area under the curve of 0.75 (95% confidence interval 0.72–0.78). A sensitivity analysis in nulliparous women proved that BMI, days of cervical priming, age, and gestational age were risk factors, whereas spontaneous start of delivery and induction were protective factors. There was one occurrence of neonatal death.ConclusionsWomen of advanced maternal age and those of very advanced maternal age have a higher chance of having an unplanned cesarean section compared to the general obstetric population in the Netherlands. Unplanned cesarean sections can be predicted through use of our predictive model. Risk increases with higher BMI, no previous vaginal delivery, and increasing number of days needed for cervical priming, whereas spontaneous start of labor lowers the risk. In nulliparous women, age and gestational age also increase risk, but induction lowers the risk of having an unplanned cesarean section.

show abstract

Section: Discussionsupporting

confidence: 89%