Primary cesarean section and adverse delivery outcomes among women of very advanced maternal age

Richards, Michael; Flanagan, Meghan R.; Littman, Alyson J.; Burke, Alson K.; Callegari, Lisa S.

doi:10.1038/jp.2015.204

Cited by 48 publications

(59 citation statements)

References 30 publications

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“…This study and related reports[ 11 - 14 ] showed that the age of pregnant women was significantly associated with cesarean section. This study showed that the rate of conversion to cesarean section in trial of labor for elderly parturient women was 8.7%.…”

Section: Discussionsupporting

confidence: 73%

Factors affecting failed trial of labor and countermeasures: A retrospective analysis

Wang¹,

Sun²,

Shen³

2020

WJCC

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BACKGROUND Vaginal delivery is the ideal mode of delivery for the termination of a pregnancy. However, the cesarean section rate in China is much higher than the published by the World Health Organization in the Lancet in 2010. AIM To retrospectively analyze the factors related to failed trial of labor and the clinical indications for cesarean section conversion, explore how to promote the trial of labor success rate, and determine the feasibility of reducing the rate of conversion to cesarean section. METHODS A retrospective analysis was performed on 9240 maternal women who met vaginal delivery conditions and required a trial of labor from January 2016 to December 2018 at our hospital. Among them, 8164 pregnant women who had a successful trial of labor were used as a control group, and 1076 pregnant women who had a failed trial of labor and converted to an emergency cesarean section were used as an observation group. The patients’ clinical data during hospitalization were collected for comparative analysis, the related factors of the failed trial of labor were discussed, and reasonable prevention and resolution strategies were proposed to increase the success rate of trial of labor. RESULTS The analysis revealed that advanced age (≥ 35 years old), macrosomia (≥ 4000 g), delayed pregnancy (≥ 41 wk), use of uterine contraction drugs, primipara, and fever during labor were associated with conversion to an emergency cesarean section in the failed trial of labor. Multivariate regression analysis showed that age, gestational age, primipara, use of uterine contraction drugs, fever during birth, and newborn weight led to a higher probability of conversion to an emergency cesarean section in the failed trial of labor. The analysis indicated that the following clinical indications were associated with the conversion to cesarean section in the failed trial of labor: Fetal distress (44.3%), social factors (12.8%), malpresentation (face presentation, persistent occipitoposterior position, and persistent occipitotransverse position) (9.4%), and cephalopelvic disproportion (8.9%). CONCLUSION The conversion to emergency cesarean section in failed trial of labor is affected by many factors. Medical staff should take appropriate preventive measures for the main factors, increase the trial of labor success rate, improve the quality of delivery, ensure the safety of mother and child during the perinatal period, and improve the relationship between doctors and patients.

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Section: Discussionsupporting

confidence: 73%

Factors affecting failed trial of labor and countermeasures: A retrospective analysis

Wang¹,

Sun²,

Shen³

2020

WJCC

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“…Organization for Economic Co-operation and Development (OECD) have raised concerns regarding the frequent and increasing use of CS [8,9]. Research studies have consistently found an association between the increase in maternal age and an increase in CS [10,11]. As morbidity tends to increase with age, any group of women with advanced maternal age will include more individuals with age-related prenatal risk factors such as hypertension [12] diabetes mellitus and high Body Mass Index (BMI) compared with a similar group of younger pregnant women [13,14].…”

Section: Original Research Articlementioning

confidence: 99%

A clinical study on indications for caesarean section among primigravida in a tertiary care centre

Nair

C.P.

P.M.

2019

Obs Gyne Reivew J Obstet Gynecol

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Background: The Primary caesarean section (CS) delivery rate is increasing due to public interest to avoid fetal complications and acceptance by most of the couple to complete their family with one or two children. High cesarean birth rates are an issue of international public health concern. Worries over such increases have led the World Health Organization to advise that Cesarean Section (CS) rates should not be more than 15%, with some evidence that CS rates above 15% are not associated with additional reduction in maternal and neonatal mortality and morbidity. Aims and Objectives: To find out the indications of caesarean section among primigravida in a tertiary care centre. Methods: A total of 100 cases were selected for the study who regularly attended outdoor (Booked) and admitted, those who booked in antenatal clinic but admitted as emergency. Results: The most common age group in the present study was 20-25 years (45%). Among the study cases, 80% were booked, 20 % were unbooked. Conclusion: Obstetric factors occurring around birth, including obstructed labor and fetal distress were the main reasons leading to Cesarean Section rather than background characteristics assumed to be a risk. The results imply that there is a need for timely and accurate screening of women during obstetric care and, decision to perform cesarean section should be based on clear, compelling and wellsupported justifications .Early referral instead of late referral from the periphery hospitals to the tertiary hospital is necessary for trial of vaginal delivery.

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“…Likewise, older mothers are more likely to have a healthy lifestyle prior to and during pregnancy compared to younger women [10–13]. Research studies have consistently found an association between the increase in maternal age and an increase in CS [14,15]. As morbidity tends to increase with age, any group of women with advanced maternal age will include more individuals with age-related prenatal risk factors such as hypertension [7,16] diabetes mellitus [10] and high Body Mass Index (BMI) compared with a similar group of younger pregnant women [17,18].…”

Section: Introductionmentioning

confidence: 99%

Cesarean section on a rise—Does advanced maternal age explain the increase? A population register-based study

et al. 2019

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BackgroundIn Denmark, the cesarean section rate has increased by 49% between 1998 and 2015 and accounts for 21% of all births. Cesarean sections may cause short- as well as long-term consequences for both the mother and the child and impose further risks in future pregnancies. Delaying pregnancy until advanced maternal age at childbirth has been suggested as contributing to the increase. The proportion of women giving birth at 35 years or above increased from 15% (1998) to 21% (2015). Advanced maternal age at childbirth has been found to be related to increased pre-pregnancy morbidity and associated risk factors that may contribute to an increased risk of cesarean section. The aim of this study was to examine the association between advanced maternal age and cesarean section in a Danish population and the influence of demographic, anthropometric, health, and obstetric factors on this association.MethodsThis study draws on a national population-based cohort study of all Danish births between 1998 and 2015 (N = 1,122,964). Maternal age less than 30 years serves as reference with the following age categories: (30–34 years); (35–39 years), and (40 years and above). The primary outcome was a cesarean section. Multivariate regression models with adjustment for demographic, health, pregnancy, fetal, and obstetric characteristics were performed with the results further stratified by parity.ResultsIn general, a positive association between advanced maternal age and cesarean section was found. Only minor changes in the risk estimate occurred after adjustment for relevant confounders. In comparison with the reference category, nulliparous women aged 35-39- years had twice the risk for cesarean section (adjusted odds ratio (AOR) 2.18, 95% confidence interval (CI) [2.11–2.26]) whereas for women of 40 years or above, the risk was more than tripled (AOR 3.64, 95% CI [3.41–3.90]). For multiparous women aged 35-39-years the risk was more moderate, but still with an AOR of 1.56, 95% CI [1.53–1.60], and for those 40 years and above, the AOR was 2.02, 95% CI [1.92–2.09].ConclusionsOverall, cesarean section increased with increasing maternal age. Adjustment for maternal and obstetric risk factors had only a minor influence on the association. The association was stronger in nulliparous women compared to multiparous women. Given the lack of impact of demographic and health risks on the relationship between maternal age and cesarean section, the authors suggest obstetric culture could be added to the list of risk factors for a cesarean. Future research on obstetric culture is recommended as are studies on a possible age-related decrease in the ability to maintain the progression of labor.Trial registrationThe study uses depersonalized register data and has been approved by the Danish Data Protection Agency (2015-41-4168).

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Primary cesarean section and adverse delivery outcomes among women of very advanced maternal age

Abstract: Primary cesarean delivery risk continues to increase above age 35 regardless of prior vaginal birth, with the highest risk among women aged 50 years and older.

Cited by 48 publications

References 30 publications

Factors affecting failed trial of labor and countermeasures: A retrospective analysis

Factors affecting failed trial of labor and countermeasures: A retrospective analysis

A clinical study on indications for caesarean section among primigravida in a tertiary care centre

Cesarean section on a rise—Does advanced maternal age explain the increase? A population register-based study

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