Does parity affect pregnancy outcomes in the elderly gravida?

Shechter‐Maor, Gil; Sadeh-Mestechkin, Dana; Paz, Yosef; Halevy, Rivka Sukenik; Markovitch, Ofer; Biron‐Shental, Tal

doi:10.1007/s00404-019-05386-4

Cited by 21 publications

(20 citation statements)

References 22 publications

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“…We, however, found this increase in prelabor cesarean birth for multiparous women only. Evidence suggests that primiparous women over 35 years of age have an increased risk of hypertensive disorders, diabetes, and intrauterine growth restriction (IUGR) compared with older multiparous women 21 . Therefore, the decreasing trend in intrapartum cesarean birth and increasing trend in prelabor cesarean births in our study for multiparas, but not primiparas, is unlikely to be explained by a higher rate of complications for multiparous women.…”

Section: Discussionmentioning

confidence: 50%

Trends in cesarean birth rates in Iceland over a 19‐year period

Haggar

Einarsdóttir

2020

Birth

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Background Cesarean birth (CB) rates have increased in high‐resource countries during the past two decades, yet it is not known whether CB rates have changed according to maternal age and/or gestational age. Methods All singleton live births in Iceland between 1997 and 2015 were identified from the Icelandic Medical Birth Registry (80 130). Rates of cesarean births (intrapartum and prelabor) were calculated overall and separately for maternal age groups and gestational age groups and by parity. Logit binomial regression was used to calculate odds ratios (ORs) and confidence intervals (CIs) for annual change in cesarean birth rates adjusted for maternal characteristics and clinical indication groups. Results The overall CB rate was 15.7% in 1997 and 15.8% in 2015; the CB rate did not change significantly during the study period. The overall CB rate for early‐term deliveries (37‐38 weeks) decreased for multiparas (annual aOR = 0.99 [95% CI = 0.98‐0.99]), and the preterm (<37 weeks) prelabor cesarean rate increased significantly (1.11 [1.09‐1.14]) for both primiparas and multiparas. For multiparas only, the intrapartum CB rate decreased (0.97 [0.97‐0.98]), whereas the prelabor CB rate increased, predominantly for women aged over 35 years (1.03 [1.02‐1.04]). Adjustment for clinical indication groups did not change these results. Conclusions Findings indicate a rise in prelabor cesarean for preterm births and women aged over 35 years (multiparas only). As adjustment for clinical indications did not affect these results, changes in obstetric practice are more likely to have affected these rate changes rather than changes in clinical indications.

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Section: Discussionmentioning

confidence: 50%

Trends in cesarean birth rates in Iceland over a 19‐year period

Haggar

Einarsdóttir

2020

Birth

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“…Advanced maternal age is a well-established risk factor for adverse pregnancy outcomes [2][3][4][5][6]. Nulliparity adds further risk [7,8], putting the advanced maternal age nullipara gravida at the focus of research studies and pregnancy surveillance. Consistent with this assumption, multiparity is considered a protective factor among all maternal ages, including among advanced maternal age parturients.…”

Section: Discussionmentioning

confidence: 99%

“…Shechter M.G. et al [8] conducted a retrospective study that aimed to evaluate the impact of parity on adverse perinatal outcome among advanced maternal age parturients (over 35 years at time of delivery). The authors demonstrated higher rates of multifetal pregnancies, preterm deliveries, hypertensive disorders, diabetes, and fetal growth restriction among nulliparas compared to multiparas gravidas.…”

Section: Discussionmentioning

confidence: 99%

“…Other than age, nulliparity is also associated with adverse pregnancy outcome [7,8], therefore, multiparity (assuming normal outcome) is considered protective. In multipara women, data suggests that interpregnancy interval (IPI), whether short (below 18 months) or long (above 60 month) has an impact on both maternal and neonatal outcome [9][10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

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Parity and Interval from Previous Delivery—Influence on Perinatal Outcome in Advanced Maternal Age Parturients

Naeh

Hallak

Gabbay‐Benziv

2021

JCM

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Objective: To investigate the effect of parity and interpregnancy interval (IPI) on perinatal outcomes in advanced maternal age (AMA) parturients. Methods: A population-based retrospective cohort study of all women older than 40 years, who had a singleton live birth after 24 weeks in the United States in 2017 Women were categorized to three groups by parity and interval from last delivery: primiparas, multiparas with IPI ≤ 5 years, and multiparas with IPI > 5 years. Primary outcome was composite adverse neonatal outcome (preterm delivery <34 weeks, birthweight <2000 g, neonatal seizure, neonatal intensive care unit admission, Apgar score <7 at 5 min, or assisted ventilation >6 h). Secondary outcome was composite adverse maternal outcome and other adverse perinatal outcomes. Univariate and multivariate analysis were used to compare between groups. Results: During 2017, 3,864,754 deliveries were recorded into the database. Following exclusion, 109,564 AMA gravidas entered analysis. Of them, 24,769 (22.6%) were nulliparas, 39,933 (36.4%) were multiparas with IPI ≤ 5 years, and 44,862 (40.9%) were multiparas with IPI > 5 years. Composite neonatal outcome was higher in nulliparas and in multiparas with IPI > 5 years, in comparison to multiparas with IPI ≤ 5 years (16% vs. 13% vs. 10%, respectively, p < 0.05). Maternal composite outcome was similar between groups. In the multivariable analysis, relative to nulliparas, only multiparity with IPI ≤ 5 years had a protective effect against the composite neonatal outcome (aOR 0.97, 95% CI 0.95–0.99, p < 0.001). Conclusion: Among AMA gravidas, multiparity with IPI ≤ 5 years has a significant protective effect against adverse neonatal outcomes when compared to nulliparas. Multiparity with IPI > 5 years is no longer protective.

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“…2 Shechter-Maor and colleagues found that cesarean sections, operative vaginal deliveries and PPH were more common among the primiparous group. 5 These studies attributed increased rates of PPH among primiparas to prolonged labors and increased rates of labor induction with long periods of oxytocin administration. In contrast, a recently conducted randomized trial demonstrated an increased incidence of PPH among multigravida deliveries.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with increased blood loss during delivery

Jain

Thakur

Jain

et al. 2020

Int J Reprod Contracept Obstet Gynecol

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Background: The present study was done to assess the blood loss during delivery even after active management of third stage of labor with oxytocin and the maternal outcomes of PPH.Methods: We studied 100 pregnant women were either in spontaneous labor or admitted for induction of labor, underwent vaginal delivery or caesarean section in our institute. Active management of third stage of labor in all 100 cases included 10 IU intramuscular oxytocin or 10 to 20 IU intravenous in 500 ml of Ringer’s Lactate. Blood loss in all cases was noted.Results: Of the included cases, 27 had to be given extra-uterotonics for atonic uterus, of which 12 parturient still had PPH. Atonic uterus was the cause of PPH in 11 of the 12 cases, while one case was of atonic uterus plus trauma. Half of all PPH cases responded to medical management alone, five cases had to undergo tamponade/stepwise devascularization and one case had to undergo obstetric hysterectomy. Blood loss was significantly higher in women aged more than 35 years, primigravida, not in labor, oligohydramnios or post-datism, elective LSCS, scarred uterus in and had more than 1 high risk factor. Among various high-risk conditions, significantly higher blood loss was observed in patients with chronic hypertension, gestational hypertension, pre-gestational diabetes mellitus, multipara with prior PPH, placenta previa, preeclampsia and sickle cell trait.Conclusions: Fifteen women avoided PPH by using a reliable method of blood loss measurement and initiating interventions early. Organized PPH management protocol morbidity and mortality of the mother and neonate can be prevented.

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Does parity affect pregnancy outcomes in the elderly gravida?

Cited by 21 publications

References 22 publications

Trends in cesarean birth rates in Iceland over a 19‐year period

Trends in cesarean birth rates in Iceland over a 19‐year period

Parity and Interval from Previous Delivery—Influence on Perinatal Outcome in Advanced Maternal Age Parturients

Factors associated with increased blood loss during delivery

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