Can obstetric complications explain the high levels of obstetric interventions and maternity service use among older women? A retrospective analysis of routinely collected data

Abstract

Objective To determine whether the higher levels of obstetric intervention and maternity service use among older women can be explained by obstetric complications. Design A retrospective analysis of routinely collected data from the Aberdeen Maternity and Neonatal Databank. Participants All residents of Aberdeen city district delivering singleton infants at the Maternity Hospital 1988Hospital -1997. Main outcome measures Odds ratios for each intervention in older maternal age groups compared with women aged 20-29. Interventions considered include obstetric interventions (induction of labour, augmentation, epidural use, assisted delivery, caesarean section) and raised maternity service use (more than two prenatal scans, amniocentesis, antenatal admission to hospital, admission at delivery of more than ®ve days, infant resuscitation, and admission to the neonatal unit).Methods Logistic regression was used to investigate the association between maternal age and the incidence of interventions. The odds ratios for each intervention were then adjusted for relevant obstetric complications and maternal socio-demographic characteristics. Results Levels of amniocentesis, caesarean section, assisted delivery, induction, and augmentation (in primiparae) are all higher among older women. Maternity service use also increases signi®cantly with age: older women are more likely to have an antenatal admission, more than two scans, a hospital stay at delivery of more than ®ve days, and have their baby admitted to a neonatal unit. Controlling for relevant obstetric complications reveals several examples of effect modi®cation, but does not eliminate the age effect for most interventions in most groups of women. Conclusions Higher levels of intervention among older women are not explained by the obstetric complications we considered.

Pregnancy after 35

“…Few women visited specialist doctors to discuss existing health issues, such as blood pressure. Choosing hospitals and birth-care options was another way in which women prepared for pregnancy, and being aware of the increased risks associated with their age, they especially valued the availability of emergency services at hospitals 16 . Having become pregnant, women adopted a different range of health promoting activities in response to their concerns and needs in relation to their pregnancy.…”

“…Bell et al (2001) found that age-related increased intervention rates were independent of maternal complications during pregnancy, complications during labour, a history of infertility, and other confounding factors. Age alone was not responsible for gestational hypertensive disorders, although chronic hypertension was found to be more common among women of advanced maternal age.…”

“…Compared to younger women, the types of complications that women over 35 years are at increased risk of during pregnancy include gestational diabetes, placenta praevia 17 ,pre-eclampsia 17 , miscarriage 18 and pregnancy-induced hypertension as well as Caesarean sections 17 . Induction of labour 16 , augmentation with primiparae and assisted deliveries are also associated with women of advanced maternal age 16 . Perinatal mortality, perinatal and neonatal death, and intra-uterine foetal death also increase with increasing age .…”

“…Perinatal mortality, perinatal and neonatal death, and intra-uterine foetal death also increase with increasing age . Older women are also more likely to have been diagnosed with conditions such as hypertensive disorders, diabetes mellitus and other chronic diseases, for which they are already taking medication 16 . These chronic medical conditions may further complicate their pregnancies.…”

“…It has been shown that advanced maternal age increases pregnancy-related risks and the probability of obstetric complications. Few studies described the risks, complications and obstetric outcomes related to pregnancy in women aged over 35 years 16 . Compared to younger women, the types of complications that women over 35 years are at increased risk of during pregnancy include gestational diabetes, placenta praevia 17 ,pre-eclampsia 17 , miscarriage 18 and pregnancy-induced hypertension as well as Caesarean sections 17 .…”