Incidence and risks of caesarean section in women aged greater than 40 years

Abstract

Objective. Evaluating the rates of childbirth in women over 40 years of age in Tuscany (Italy) outlining the indications for caesarean section in this parturient population. Methods. 227,871 women who delivered in Tuscany from 2011 to 2018 using data of Birth Assistance Certificate linked with hospital discharge registry were observed. Caesarean section indications were reported as dismissal diagnoses. Logistic models (adjusted for parity, ART and BMI) were carried out for the maternal age risk factor. Results. The caesarean section rate increases significantly with age. Multivariate analysis confirmed that women over 40 years of age have a higher risk of a caesarean section due to pathologies such as diabetes or eclampsia which are clearly more frequent in these categories of women. Furthermore, the data shows that the caesarean section in some cases was carried out due solely to the age of a primiparous woman. Conclusions. The phenomenon affects health services and social costs and should make us reflect upon the underlying reasons that bring women to delay their reproductive project and where necessary implement appropriate political strategies. SOMMARIO Scopo. Valutare il parto nelle donne over 40 in Toscana e descrivere le indicazioni al taglio cesareo in questa popolazione. Metodi. Da Certificato di Assistenza al Parto linkato con la SDO sono state estratte 227.871 donne che hanno partorito in Toscana tra il 2011 e il 2018. Attraverso le diagnosi di dimissione è stato possibile identificare le principali indicazioni al cesareo. Per queste sono stati effettuati dei modelli logistici (univariati e multivariati aggiustati per parità, PMA e BMI) per il fattore di rischio età materna. Risultati. Aumenta significativamente all'aumentare dell'età il ricorso al taglio cesareo, soprattutto quello di elezione e quello in urgenza, a testimonianza di una maggiore incidenza di condizioni patologiche. L'analisi multivariata conferma per le over 40 un rischio maggiore di taglio cesareo a causa di patologie come il diabete o l'eclampsia che risultano chiaramente più frequenti in queste categorie di donne. I dati mostrano inoltre che in alcuni casi il cesareo viene effettuato solo per indicazione materna. Conclusioni. Questo incide sui servizi sanitari e sui costi sociali e dovrebbe fare riflettere sulle motivazioni che conducono le donne a ritardare il loro progetto riproduttivo mettendo in atto scelte politiche conseguenti e adeguate.

Bilobed placenta and management choices: liture review and two cases studies

“…This finding should be taken into account by clinicians regarding the rarity of this placental morphological variation. Hypothesized risk factors include advanced maternal age, maternal history of infertility, smoking, and diabetes [5,9,[25][26][27][28].…”

Bladder invasion of placenta percreta: review of literature and our experience

“…The management of placenta percreta is a controversial topic. Placenta abnormalities that cause a pathological pregnancy and previous caesarean scar are one of the main indications for women over 40 years of age to undergo caesarean section [19]. As for the Royal College guidelines [12] four surgical approaches are viable: • Primary hysterectomy following delivery of the foetus, without attempting placental separation.…”

Role of pelvic packing in massive obstetric haemorrhage with severe coagulopathy: a case report

“…The incidence of cesarean delivery (CD) is increasing, and thus the standard blood loss during CD (1000 mL) is double the amount lost during vaginal delivery (500 mL) [3]. CD rate as high as 25-30% in many areas of the earth [4].…”