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A woman 45 years of age or older is considered to be of very advanced maternal age. In Australia, 0.1% of parturients are in this category at present. The investigators undertook a retrospective cohort study of women aged 45 or above at the time of delivery, all of whom delivered at 20 or more weeks of gestation. In the 108,818 women reviewed, 76 women of very advanced maternal age had 77 pregnancies (incidence ϭ 0.7 per 1000 births). The mean age was 46 years. Sixteen women in the study were primiparous. In multiparas, a mean of 8.8 years had passed since the last live birth. More than half the women had had at least one miscarriage and 13 (17% of the total) reported having 3 or more. Only 14% of women required assisted reproduction. The most frequent medical problems were depression, present in 9 women, and uterine leiomyomas in 4. No chromosomal abnormalities were found in the 53% of pregnancies that were evaluated.Two thirds of pregnancies were free of complications. Ten women had pregnancy-related hypertensive disorders compared with 10% of women 20 to 29 years of age. Two women were delivered before term because of preeclampsia. Gestational diabetes was diagnosed in 8% of pregnancies; only one woman received insulin. Labor began spontaneously in 36% of pregnancies and was induced in 17%, most often "electively" or because of postdate status or spontaneous rupture of membranes at term. The rate of cesarean section was 49% compared with 23% in the younger women. Four women required manual removal of the placenta because of bleeding, and 3 had postsection wound infections.Eight of 78 live-born infants were small-for-gestational age, whereas 6 were large-for-gestational age. Seven singleton births and both sets of twins were born prematurely for a variety of reasons, the most common being premature rupture of membranes. Thirteen infants, 17% of the total, were admitted to the special care nursery; prematurity and respiratory distress syndrome accounted for 6 and 4 admissions, respectively. The overall rate of special care was 16.5%. Five infants in the study group (6%) had congenital abnormalities.The findings in this large-scale study of women aged 45 or above are, in general, reassuring for older women who are in good health and who have a chromosomally normal fetus.

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Preterm neonates exposed to painful NICU procedures exhibit increased pain scores and alterations in oxygenation and heart rate. It is unclear whether these physiologic responses increase the risk of oxidative stress. Using a prospective study design, we examined the relationship between a tissue-damaging procedure (TDP, tape removal during discontinuation of an indwelling central arterial or venous catheter) and oxidative stress in 80 preterm neonates. Oxidative stress was quantified by measuring uric acid (UA) and malondialdehyde (MDA) concentration in plasma before and after neonates experienced a TDP (n=38) compared to those not experiencing any TDP (control group, n=42). Pain was measured before and during the TDP using the Premature Infant Pain Profile(PIPP). We found that pain scores were higher in the TDP group compared to the control group (median scores:11 and 5, respectively, P<0.001). UA significantly decreased over time in control neonates but remained stable in TDP neonates (132.76μM to 123.23μM vs.140.50μM to 138.9μM, P=0.002). MDA levels decreased over time in control neonates but increased in TDP neonates (2.07μM to 1.81μM vs. 2.07μM to 2.21μM, P=0.01). We found significant positive correlations between PIPP scores and MDA. Our data suggest a significant relationship between procedural pain and oxidative stress in preterm neonates.