Pregnancy in the Sixth Decade of Life: Obstetric Outcomes in Women of Advanced Reproductive Age

Abstract

An estimated 7% of pregnant women sustain trauma; a recent report claims 3.7 traumatic fetal deaths for every 100,000 live births. It seems likely that fetal mortality is increased even in cases of minor injury. The present survey of 112 emergency medicine residency programs at teaching hospitals yielded 87 responses (response rate, 78%). The 25-question survey asked about what routines are followed for assessing injured pregnant women and included a few hypothetical patients.A large majority of respondents (78%) reported routinely monitoring women with a viable fetus for 2 to 4 hours for anything more than minor extremity injury. One in five, however, instituted monitoring only for abdominal tenderness or pain. When fetal monitoring is carried out in the emergency department, an obstetric physician is involved more than half the time. Only 15% of programs have cardiotocographic equipment in the emergency department, and of the others, only one third have an established protocol for checking fetal heart tones (usually at 15-minute intervals). Nearly half of the programs would monitor the fetus routinely after a fall even if there were no abdominal pain or bleeding. Sonographic equipment is available in half the units. With a fetus of nonviable age, sonography usually is done only when there is lower abdominal pain. Without exception the programs have continual access to in-house emergency obstetrical consultation. When there is no obvious injury, the mechanism of injury is an important factor when deciding whether to carry out monitoring. For instance, ejection from a vehicular rollover and direct blunt abdominal trauma in an assault would prompt monitoring.This survey of emergency medicine residency programs indicate that the commonest approach to blunt trauma in pregnant women is to clear the mother in the emergency department and not monitor the fetus. Later patients are selectively sent to the obstetric area to check the fetus. ABSTRACTOver the past two decades, immediate or delayed hypersensitivity to latex antigens has assumed increasing importance as a medical problem in various patient populations. This study attempted to determine the seroprevalence of anti-latex immunoglobulin E (IgE) antibodies in patients 18 years and older who presented to an emergency department. Titers of latex-specific IgE antibody were measured using a latex-specific IgG assay (the AlaSTAT Microplate Latex-Specific IgE Assay) in 1027 patients. In addition, serum IgE antibody to 12 common inhalant allergens were estimated by the allergy screen assay. The patients included in the study had a mean age of 47. Just more than half were females, and a large majority was nonwhite.The rate of seropositivity for latex-specific IgG was 8.2%, and the rate of positive AlaTOP results was 42%. Of patients who were seropositive for latex antibody, 24% were rated as strongly positive. Being nonwhite increased the likelihood of latex-specific seropositivity (odds ratio, 4.7), as did being seropositive for inhalant allergens (odds ratio, 7.4). It s...

Monozygotic Twins and Triplets in Association with Blastocyst Transfer

“…Although the cesarean section rate is not dissimilar from other ART cohorts (14), the 50% rate of selective reduction is much higher than the 3-5% rate annually observed at our center. The incidence of obstetrical complications associated with monozygotic twins including pregnancy-induced hypertension and postdates (both 1/6 (16.6%) in this cohort) may not be meaningful when compared to singleton and dizygotic twin pregnancies due to the small sample.…”

La edad de la mujer como factor de riesgo de mortalidad materna, fetal, neonatal e infantil

“…Son escasos los estudios en mujeres de 50 o más años con gestaciones espontáneas 12,36 , mientras que otros corresponden a estudios descriptivos de embarazos por ovo donación en mujeres seleccionadas 37,38 .…”

Paternal age and reproduction

“…The Caesarean delivery rate increases with maternal age (Rosenthal and Paterson-Brown, 1998;Ecker et al, 2001;Paulson et al, 2002;Ahmed et al, 2004;Dhillo et al, 2005) also in mothers in their sixth decade of life who conceived by IVF with oocytes of young donors (mean donor age: 27.5 years) (Paulson et al, 2002).…”