Obstetric outcome of elderly low-risk nulliparae

Smit, Yvonne; Scherjon, Sicco A.; Knuist, M; Treffers, P.E.

doi:10.1016/s0020-7292(98)00121-0

Cited by 8 publications

(18 citation statements)

References 18 publications

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“…Older women more commonly have pregnancy complications such as preterm delivery, multiple gestation, fetal malposition, placenta praevia and medical illness that increase the rate of operative delivery. Smit et al 21 found no increased risk for women ‡35 years of age for failure to progress in the first and the expulsive second stage of labour, but this study concerned a low-risk population and did not differentiate ages over 35 years. However, other authors reported older maternal age to be associated with protracted labour, Caesarean section and increased rates of vaginal operative delivery, 15,22 and have suggested a continuous decrease in myometrial function with increasing age.…”

Section: Discussionmentioning

confidence: 75%

Indicators for intervention during the expulsive second‐stage arrest of labour

Leushuis

Tromp²,

Ravelli³

et al. 2009

BJOG

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Objective To identify antepartum and intrapartum indicators of obstetric interventions during the expulsive second-stage arrest of labour.Design Retrospective cohort study. Setting The Netherlands.Population A cohort of 389 086 women with singleton, cephalic, term, live-birth deliveries from 2002 to 2004 who had entered the expulsive second stage of labour. Of all these deliveries, 37 899 (9.7%) were complicated by expulsive second-stage arrest of labour. Women with a prior Caesarean section or women undergoing an elective Caesarean section were excluded.Methods All deliveries in the Netherlands from 2002 to 2004 were registered in the Netherlands Perinatal Registry, which contains the linked and validated data of three databases. Uni-and multivariable logistic regression analyses were performed.Main outcome measures Ante-and intrapartum indicators for interventions during expulsive second-stage arrest of labour.Results Primiparous delivery was the most important antepartum indicator for intervention during expulsive second-stage arrest. Using multivariable analysis the following antepartum indicators were associated with intervention for expulsive second-stage arrest of primiparous labour: maternal age, gestational age, diabetes, hypertension and labour induction. Prominent intrapartum indicators for primiparous deliveries were fetal head position and oxytocin augmentation.Conclusion Multiple significant antepartum and intrapartum indicators associated with intervention for expulsive second-stage arrest of labour were identified in this large retrospective study. Prominent were the associations of parity, maternal age and fetal head position with expulsive second-stage arrest. The identified factors should be further evaluated in prospective studies that aim to develop prediction models.

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Section: Discussionmentioning

confidence: 75%

Indicators for intervention during the expulsive second‐stage arrest of labour

Leushuis

Tromp²,

Ravelli³

et al. 2009

BJOG

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“…However, AMA alone in otherwise low risk pregnancies has been associated with nearly as good pregnancy outcomes as in younger women and according to some studies maternal age alone is not a risk factor explaining the adverse outcomes, but associated with other risk factors like hypertension and diabetes may account for the results [13,14]. Co-existing risks accompanied with the ageing process jeopardize the outcome much more than in younger age groups, as we have shown previously in the case of smoking women and women affected by preeclampsia, both having been complicated by advanced age [15,16].…”

Section: Introductionmentioning

confidence: 99%

Pregnancy outcomes of overweight and obese women aged 35 years or older – A registry-based study in Finland

Lamminpää

Vehviläinen‐Julkunen

Gissler

et al. 2016

Obesity Research & Clinical Practice

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SummaryObjective: To compare pregnancy outcomes of overweight and obese pregnant women aged 35 years or older to women aged less than 35 years old. Methods: A registry-based study covering years 2004-2008 including data on women ≥35 years (N = 45,718) compared to those <35 years (N = 203,930) and their prepregnancy body mass index (BMI) (<25, 25-29 and ≥30). In multivariable modelling, the main outcome measures were preterm delivery (<28 weeks, 28-31weeks and 32-36 weeks), low Apgar scores at 5 min, small-for-gestational age (SGA), foetal death, asphyxia, Caesarean section, induction, preeclampsia, blood transfusion, admission to a neonatal intensive care unit (NICU), shoulder dystocia, and large for gestational age (LGA). Results: Maternal overweight and obesity along with advanced maternal age (AMA) significantly increased the risks of preterm delivery, preeclampsia, foetal death, LGA and Caesarean as compared to women of average weight aged <35 years. When comparing overweight and obese women aged ≥35 years to normal weight women * Corresponding author. Tel.: +358 503816972. E-mail address: reeta.lampinen@uef.fi (R. Lamminpää). of the same age, the rates of preeclampsia, preterm delivery <28 weeks, LGA and low Apgar score were significantly increased. When observing overweight and obese women <35 years as a reference group, the risks of preterm delivery and foetal death were significantly increased. Conclusions: The risks were increased by maternal age ≥ 35 years and both obesity and overweight. The combined effect of AMA and either overweight or obesity appeared to be a high risk state particularly for stillbirth and preterm delivery.

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“…Previous studies by Naqvi MM et al, Smit S et al and Adashek et al also showed a higher incidence of caesarean section in elderly nulliparous women. [20][21][22] There were 69 cases of elective caesarean section in the study group (36%) compared to 12 cases in the control group (6%). The major indications for elective caesarean section was elderly primi having some complications and cephalopelvic disproportion for the elderly group and placenta previa for the control group; whereas that for emergency procedures was failed induction in both the groups.…”

Section: Discussionmentioning

confidence: 99%