Effect of very advanced maternal age on pregnancy outcome and rate of cesarean delivery

被引:133
作者
Dulitzki, M
Soriano, D
Schiff, E
Chetrit, A
Mashiach, S
Seidman, DS [1 ]
机构
[1] Chaim Sheba Med Ctr, Dept Obstet & Gynecol, IL-52621 Tel Hashomer, Israel
[2] Tel Aviv Univ, Sackler Sch Med, IL-69978 Tel Aviv, Israel
关键词
D O I
10.1016/S0029-7844(98)00335-4
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Objective: To determine outcomes of pregnancies in women at least 44 years of age and to determine factors predicting cesarean delivery in these patients. Methods: Between January 1988 and December 1995, 109 women at least 44 years old delivered in our medical center. These women were matched to a group of 309 women 20-29 years of age. Multiple logistic regression analysis was used to evaluate the association between maternal age and outcome variables, controlling for possible confounding factors. Based on the logistic regression, a predictive model was calculated for cesarean delivery and validated prospectively in a separate group of 30 consecutive women at least 44 years old, who delivered during the first 8 months of 1996. Results: Very advanced maternal age, compared with younger age, was associated with a significantly higher rate of medical complications (hypertensive disorder and diabetes) (odds ratio [OR] 2.5; 95% confidence interval [CI] 1.5, 4.1; P < .001), instrument-assisted vaginal delivery (OR 7.5; 95% CI 2.2, 25.0; P < .004), and cesarean delivery (OR 7.3; 95% CI 2.2, 16.7; P < .001). The incidences of preterm labor, premature rupture of membranes, emergency cesarean delivery, meconium-stained amniotic fluid, small for gestational age newborns, and 5-minute Apgar scores of 7 or lower were not influenced by maternal age. The regression model showed an increased risk for cesarean delivery associated with age of at least 44 years (OR 7.3; 95% CI 2.2, 16.7), primiparity (OR 3.5; 95% CI 1.3, 9.8), infertility treatment (OR 3.6; 95% CI 1.5, 8.8), and egg donation (OR 19.5; 95% CI 6.1, 62.2), with positive acid negative predictive values of 94 and 86%, respectively. Conclusion: Maternal age of at least 44 years is associated with medical complications in pregnancy and more interventions during labor. However, overall pregnancy outcomes are favorable. Cesarean delivery can be predicted accurately based on maternal age, parity, and infertility treatment. (Obstet Gynecol 1998;92:935-9. (C) 1998 by The American College of Obstetricians and Gynecologists.).
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页码:935 / 939
页数:5
相关论文
共 15 条
[1]   MATERNAL AGE AT 1ST CHILDBIRTH AND RISK OF LOW-BIRTH-WEIGHT AND PRETERM DELIVERY IN WASHINGTON-STATE [J].
ALDOUS, MB ;
EDMONSON, MB .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1993, 270 (21) :2574-2577
[2]   DELAYED CHILDBEARING AND THE OUTCOME OF PREGNANCY [J].
BERKOWITZ, GS ;
SKOVRON, ML ;
LAPINSKI, RH ;
BERKOWITZ, RL .
NEW ENGLAND JOURNAL OF MEDICINE, 1990, 322 (10) :659-664
[3]   Pregnancy outcome at age 40 and older [J].
Bianco, A ;
Stone, J ;
Lynch, L ;
Lapinski, R ;
Berkowitz, G ;
Berkowitz, RL .
OBSTETRICS AND GYNECOLOGY, 1996, 87 (06) :917-922
[4]   UNDERAPPRECIATED RISKS OF THE ELDERLY MULTIPARA [J].
BOBROWSKI, RA ;
BOTTOMS, SF .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 1995, 172 (06) :1764-1770
[5]  
CNATTINGIUS S, 1992, JAMA-J AM MED ASSOC, V268, P886
[6]  
Dildy GA, 1996, AM J OBSTET GYNECOL, V175, P668
[7]  
Dollberg S, 1996, J Perinatol, V16, P93
[8]   PREGNANCY OUTCOME IN NULLIPAROUS WOMEN AGED 35 OR OLDER [J].
EDGE, V ;
LAROS, RK .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 1993, 168 (06) :1881-1885
[9]  
GRIMES DA, 1981, OBSTET GYNECOL, V58, P614
[10]   PREGNANCY OUTCOME IN MEDICALLY COMPLICATED AND UNCOMPLICATED PATIENTS AGED 40 YEARS OR OLDER [J].
LEHMANN, DK ;
CHISM, J .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 1987, 157 (03) :738-742