Increased risk in the elderly parturient

Montán, Sven

doi:10.1097/gco.0b013e3280825603

Cited by 102 publications

(83 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Alpha thalassemia was found to be higher in pregnant women ≤ 16 years than in the other groups. This can be explained in that those pregnant women could be from the prevalent community of persons with Medical complications in advanced maternal age including diabetes mellitus, hypertensive disorder in pregnancy and thyroid disease were strongly associated with stillbirth and low birth weight infants and corresponded with the previous studies [21,22]. This can be explained that abnormal thyroid functions and lung diseases were more common among those in the advanced maternal age group because of the maternal exposure to toxic substances or delayed hypersensitivity.…”

Section: Discussionsupporting

confidence: 53%

Adverse pregnancy outcomes in extremely maternal age

Chawanpaiboon¹,

Hengrasmee²

2013

OJOG

View full text Add to dashboard Cite

Objective: To study the adverse outcome in pregnant women ≤ 16 and ≥ 40 years. Study Design: A total of 1100 cases, 1061 cases of pregnant women ≤ 16 years, 20 -29 and ≥ 40 years with completed charts between 1st January, 2006 to 31st December, 2010, were enrolled in this study. The patient data includeing demographic data, hospital course, maternal laboratory investigations, maternal complications, placental complications and neonatal outcomes were recorded. SPSS version 14, one-way Anowa, Chi-square and analysis of varience were used to compare the data among two and three groups. Results: Anemia, underlying medical diseases including heart, thyroid and pulmonary diseases, obstetric complications including severe pre-eclampsia and gestational diabetes mellitus, placenta previa and preterm labour; medical administrations including magnesium sulfate, dexamethasone and bricanyl, outcome of deliveries and neonatal outcomes, were different with statistical significance between the 3 groups of pregnant women. Conclusion: Adverse maternal and neonatal outcomes were mostly found in the pregnant women ≤ 16 and ≥ 40 years. Education of contraception, safe sex and effective care during pregnancy of both extremely maternal age groups should be implemented to reduce those poor outcomes.

show abstract

Section: Discussionsupporting

confidence: 53%

Adverse pregnancy outcomes in extremely maternal age

Chawanpaiboon¹,

Hengrasmee²

2013

OJOG

View full text Add to dashboard Cite

show abstract

“…Many studies have reported an association between advanced maternal age and a higher risk of adverse maternal and infant outcomes 4, 5, 6. However, the majority of studies have reported outcomes in women aged ≥35 years or women aged ≥40 years.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy at very advanced maternal age: a UK population‐based cohort study

Fitzpatrick

Tuffnell

Kurinczuk

et al. 2016

BJOG

105

104

View full text Add to dashboard Cite

ObjectivesTo describe the characteristics, management and outcomes of women giving birth at advanced maternal age (≥48 years).DesignPopulation‐based cohort study using the UK Obstetric Surveillance System (UKOSS).SettingAll UK hospitals with obstetrician‐led maternity units.PopulationWomen delivering at advanced maternal age (≥48 years) in the UK between July 2013 and June 2014 (n = 233) and 454 comparison women.MethodsCohort and comparison group identification through the UKOSS monthly mailing.Main outcome measuresPregnancy complications.ResultsOlder women were more likely than comparison women to be overweight (33% versus 23%, P = 0.0011) or obese (23% versus 19%, P = 0.0318), nulliparous (53% versus 44%, P = 0.0299), have pre‐existing medical conditions (44% versus 28%, P < 0.0001), a multiple pregnancy (18% versus 2%, P < 0.0001), and conceived following assisted conception (78% versus 4%, P < 0.0001). Older women appeared more likely than comparison women to have pregnancy complications including gestational hypertensive disorders, gestational diabetes, postpartum haemorrhage, caesarean delivery, iatrogenic and spontaneous preterm delivery on univariable analysis and after adjustment for demographic and medical factors. However, adjustment for multiple pregnancy or use of assisted conception attenuated most effects, with significant associations remaining only with gestational diabetes (adjusted odds ratio [aOR] 4.81, 95% CI 1.93–12.00), caesarean delivery (aOR 2.78, 95% CI 1.44–5.37) and admission to an intensive care unit (aOR 33.53, 95% CI 2.73–412.24).ConclusionsWomen giving birth at advanced maternal age have higher risks of a range of pregnancy complications. Many of the increased risks appear to be explained by multiple pregnancy or use of assisted conception.Tweetable abstractThe pregnancy complications in women giving birth aged 48 or over are mostly explained by multiple pregnancy.

show abstract

“…158 However, this study, because of its relatively small size, was not able to investigate in-depth potential causes for the observed differences between individual minority groups, only between ethnic minority women as a whole and white women. Recent work has also suggested poorer outcomes of pregnancy in older women 178 and an over-representation of socially disadvantaged women among mothers who died. 3 Infant mortality is known to be much higher among routine and manual socioeconomic groups 179,180 but social inequalities in near-miss maternal morbidity have not been investigated on a national basis in the UK.…”

Section: Introductionmentioning

confidence: 99%

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Knight

Acosta

Brocklehurst

et al. 2016

Programme Grants Appl Res

101

View full text Add to dashboard Cite

BackgroundStudies of maternal mortality have been shown to result in important improvements to women’s health. It is now recognised that in countries such as the UK, where maternal deaths are rare, the study of near-miss severe maternal morbidity provides additional information to aid disease prevention, treatment and service provision.ObjectivesTo (1) estimate the incidence of specific near-miss morbidities; (2) assess the contribution of existing risk factors to incidence; (3) describe different interventions and their impact on outcomes and costs; (4) identify any groups in which outcomes differ; (5) investigate factors associated with maternal death; (6) compare an external confidential enquiry or a local review approach for investigating quality of care for affected women; and (7) assess the longer-term impacts.MethodsMixed quantitative and qualitative methods including primary national observational studies, database analyses, surveys and case studies overseen by a user advisory group.SettingMaternity units in all four countries of the UK.ParticipantsWomen with near-miss maternal morbidities, their partners and comparison women without severe morbidity.Main outcome measuresThe incidence, risk factors, management and outcomes of uterine rupture, placenta accreta, haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, severe sepsis, amniotic fluid embolism and pregnancy at advanced maternal age (≥ 48 years at completion of pregnancy); factors associated with progression from severe morbidity to death; associations between severe maternal morbidity and ethnicity and socioeconomic status; lessons for care identified by local and external review; economic evaluation of interventions for management of postpartum haemorrhage (PPH); women’s experiences of near-miss maternal morbidity; long-term outcomes; and models of maternity care commissioned through experience-led and standard approaches.ResultsWomen and their partners reported long-term impacts of near-miss maternal morbidities on their physical and mental health. Older maternal age and caesarean delivery are associated with severe maternal morbidity in both current and future pregnancies. Antibiotic prescription for pregnant or postpartum women with suspected infection does not necessarily prevent progression to severe sepsis, which may be rapidly progressive. Delay in delivery, of up to 48 hours, may be safely undertaken in women with HELLP syndrome in whom there is no fetal compromise. Uterine compression sutures are a cost-effective second-line therapy for PPH. Medical comorbidities are associated with a fivefold increase in the odds of maternal death from direct pregnancy complications. External reviews identified more specific clinical messages for care than local reviews. Experience-led commissioning may be used as a way to commission maternity services.LimitationsThis programme used observational studies, some with limited sample size, and the possibility of uncontrolled confounding cannot be excluded.ConclusionsImplementation of the findings of this research could prevent both future severe pregnancy complications as well as improving the outcome of pregnancy for women. One of the clearest findings relates to the population of women with other medical and mental health problems in pregnancy and their risk of severe morbidity. Further research into models of pre-pregnancy, pregnancy and postnatal care is clearly needed.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

show abstract

Increased risk in the elderly parturient

Abstract: Increasing maternal age is independently associated with specific adverse outcomes. Increasing age is a continuum rather than threshold effect. More information about obstetric consequences of delayed childbearing is needed both for obstetricians and fertile women.

Cited by 102 publications

References 19 publications

Adverse pregnancy outcomes in extremely maternal age

Adverse pregnancy outcomes in extremely maternal age

Pregnancy at very advanced maternal age: a UK population‐based cohort study

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Contact Info

Product

Resources

About