240: Risks of labor induction in nulliparous women with advanced maternal age

OBJECTIVE to evaluate whether advanced maternal age (AMA) is associated with prelabor cesarean section and to identify the factors associated with prelabor cesarean section in AMA women, according to the mode of type of labor financing (private or public). METHODS Based on the Birth in Brazil survey, the research was conducted on representative sample of mothers for the country (Brazil), regions, type of hospital and location (capital or not), in 2011/2012. This study included 15,071 women from two age groups: 20–29 years and ≥ 35 years. The information was collected from interviews with puerperal woman, prenatal cards, and medical records of mothers and newborns. Multiple logistic regression modelling was used to verify the association between prelabor cesarean section and maternal, prenatal and childbirth characteristics, according to the mode of financing. RESULTS Our results showed a higher use of prelabor cesarean section for AMA (≥ 35 years) women in the public service (OR = 1.63; 95%CI 1.38–1.94) and in the private service (OR = 1.44; 95%CI 1.13–1.83), compared with women aged 20–29 years. In the adjusted model, we recorded three factors associated with the prelabor cesarean section in AMA women in both, public and private sectors: the same professional in prenatal care and childbirth (OR = 4.97 and OR = 4.66); nulliparity (OR = 6.17 and OR = 10.08), and multiparity with previous cesarean section (from OR = 5.73 to OR = 32.29). The presence of obstetric risk (OR = 1.94; 95%CI .44–2.62) also contributed to the occurrence of prelabor cesarean section in women who gave birth in the public service. CONCLUSIONS AMA was an independent risk factor for prelabor cesarean in public and private services. In the public, prelabor cesarean in AMA was more influenced by clinical criteria. Higher chance of prelabor cesarean section in nulliparous women increases the chance of cesarean section in multiparous women, as we showed in this study, which increases the risk of anomalous placental implantation.

Download Full-text

Predicting the Antepartum Factors Resulted in Failed Labor Induction in Nulliparous Term Pregnancies

Fertility, Gynecology and Andrology ◽

10.5812/fga.116419 ◽

2021 ◽

Vol 1 (1) ◽

Author(s):

Mahboobeh Shirazi ◽

Batool Ghorbani Yekta ◽

Mansour Shamsipour ◽

Shirin Kharazi Kalejahi ◽

Marjan Ghaemi

Keyword(s):

Maternal Age ◽

Healthcare Providers ◽

Perinatal Outcomes ◽

Labor Induction ◽

Normal Vaginal Delivery ◽

Bishop Score ◽

Singleton Pregnancy ◽

Fetal Head ◽

Nulliparous Women ◽

Vaginal Deliveries

Objectives: This study aimed to evaluate the feasibility of using a computerized machine to predict a successful normal vaginal delivery and determine the antepartum factors involved in failed labor induction in nulliparous term women. Methods: This prospective cohort study was conducted in Yas Hospital affiliated with Tehran University of Medical Sciences from 2017 to 2019. The data used for the computerized system were obtained during the admission of the term nulliparous women with singleton pregnancy in cephalic presentation. The cesarean delivery rate, as well as maternal and perinatal outcomes, were evaluated. The input variables were maternal age, gravida, gestational age at birth, necessity and type of labor induction, presentation of the baby at birth, Bishop Score, fetal weight, and fetal head circumference, and maternal disorders. The outputs were vaginal deliveries or cesarean sections. Results: The rate of cesarean section was 41.8% (n = 287). Higher maternal age (OR = 1.044, P = 0.018, CI = 1.007 - 1.082), lower Bishop Score (OR = 0.192, P < 0.001, CI = 0.139 - 0.256) and non-occiput anterior position (OR = 82.194, P < 0.001, CI = 15.888 - 425.214) were significantly associated with failed induction. Conclusions: The result of this study may be beneficial for healthcare providers to predict the delivery route, the risk of labor induction failure and make a personal decision according to each individual.

Download Full-text

The Association between Advanced Maternal Age and Diagnosis of Small for Gestational Age

American Journal of Perinatology ◽

10.1055/s-0039-1694775 ◽

2019 ◽

Vol 37 (01) ◽

pp. 037-043 ◽

Cited By ~ 2

Author(s):

Anna Palatnik ◽

Sarah De Cicco ◽

Liyun Zhang ◽

Pippa Simpson ◽

Judith Hibbard ◽

...

Keyword(s):

Gestational Age ◽

Small For Gestational Age ◽

Maternal Age ◽

Advanced Maternal Age ◽

The United States ◽

Age Group ◽

Nulliparous Women ◽

Increased Risk ◽

Multiparous Women ◽

Multivariable Analyses

Abstract Objectives To identify whether advanced maternal age (AMA), defined as age ≥35 years old, is independently associated with small for gestational age (SGA). Study Design This was a retrospective cohort of births from the National Vital Statistics System in the United States from 2009 to 2013. Women were categorized based on four age groups at the time of delivery: 20 to 29, 30 to 34, 35 to 39, and ≥40 years old. The primary outcome of SGA < 10th and SGA < 5th percentiles was compared between the four groups using both univariable and multivariable analyses to determine whether maternal age was associated with SGA independent of parity. Results A total of 17,031,005 births were eligible for analysis, with 2,705,501 births to AMA women. In multivariable analyses, maternal age of 30 to 34, compared with 20 to 29, was associated with lower rates of SGA < 10th and <5th percentiles (adjusted odds ratio [aOR] = 0.95; 95% confidence interval [CI]: 0.95–0.96 and aOR = 0.97; 95% CI: 0.96–0.98, respectively). The AMA of 35 to 39, compared with 20 to 29, was associated with lower rates of SGA < 10th percentile and unchanged rates of SGA < 5th percentile (aOR = 0.97; 95% CI: 0.96–0.98 and aOR = 1; 95% CI: 0.99–1.01, respectively). In contrast, AMA of ≥40, compared with age 20 to 29, was associated with higher rates of both SGA < 10th and <5th percentiles (aOR = 1.06; 95% CI: 1.04–1.07 and aOR = 1.14; 95% CI: 1.12–1.16, respectively). A significant association was found between maternal age and parity toward the risk of SGA (p < 0.001). Nulliparous women ≥30 years old but not multiparous women had higher rates of SGA < 10th and SGA < 5th percentiles compared with nulliparous women in the age group of 20 to 29. In contrast, both nulliparous and multiparous women age ≥40 years old had an increased risk for SGA < 5th percentile compared with all women in the age group of 20 to 29. Conclusion Nulliparous women aged 30 years and older have higher risk of SGA < 10th and SGA < 5th percentiles compared with nulliparous women age 20 to 29. In contrast, both nulliparous and multiparous women age 40 years and older have an increased risk of SGA < 5th percentile compared with all women in the age group of 20 to 29.

Download Full-text

Single indication of labor induction with prostaglandins: is advanced maternal age a risk factor for cesarean section? A matched retrospective cohort study

The Journal of Maternal-Fetal & Neonatal Medicine ◽

10.3109/14767058.2012.746658 ◽

2012 ◽

Vol 26 (7) ◽

pp. 665-668 ◽

Cited By ~ 11

Author(s):

Alessandro Favilli ◽

Marta Maddalena Acanfora ◽

Vittorio Bini ◽

Roberta Radicchi ◽

Gian Carlo Di Renzo ◽

...

Keyword(s):

Risk Factor ◽

Cohort Study ◽

Cesarean Section ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Maternal Age ◽

Advanced Maternal Age ◽

Labor Induction

Download Full-text

Advanced maternal age and factors associated with neonatal near miss in nulliparous and multiparous women

Cadernos de Saúde Pública ◽

10.1590/0102-311x00222218 ◽

2019 ◽

Vol 35 (12) ◽

Author(s):

Katrini Guidolini Martinelli ◽

Silvana Granado Nogueira da Gama ◽

André Henrique do Vale de Almeida ◽

Vanessa Eufrauzino Pacheco ◽

Edson Theodoro dos Santos Neto

Keyword(s):

Maternal Age ◽

Advanced Maternal Age ◽

Healthcare Services ◽

Near Miss ◽

Multiple Gestation ◽

Access To Health Services ◽

Maternal Characteristics ◽

Nulliparous Women ◽

Multiparous Women ◽

Neonatal Near Miss

The early neonatal period accounts for approximately half of the deaths of young children under one year of age, and the neonatal near miss can recognize factors causing this high number of deaths. Thus, the aim of this study is to determine whether advanced maternal age increases the chance of neonatal near miss, in addition is to identify which factors are associated with the neonatal near miss, stratified by parity. Data are from the 2011-2012 Birth in Brazil study, which used a national population-based sample of 15,092 newborns of women between 20-29 and 35 years of age or more (advanced maternal age). Multiple logistic regression was performed to test the association between neonatal near miss and prenatal and childbirth variables, pre-gestational diseases, obstetric history and socioeconomic characteristics, stratified by parity. Advanced maternal age was to be statistically associated with neonatal near miss in nulliparous (OR = 1.62; 95%CI: 1.05-2.50) and multiparous (OR = 1.51; 95%CI: 1.20-1.91) when compared to women 20-29 years of age. For nulliparous women, the main variables statistically associated with neonatal near miss were multiple gestation (OR = 8.91) and hypertensive disease (OR = 2.57), whereas forceps-assisted vaginal delivery (OR = 7.19) and multiple gestation (OR = 4.47) were the variables associated for multiparous women. Neonatal near miss has been shown to be connected with access to health services for childbirth, gestational complications and maternal characteristics, mainly advanced maternal age. Therefore, to properly monitor and classify maternal gestational risk, to control gestational complications during prenatal care, and to correctly refer these women to childbirth care should be priority strategies for healthcare services.

Download Full-text