Prelabor cesarean section: the role of advanced maternal age and associated factors

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.

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Cesarean Section in Nulliparous Women of Advanced Maternal Age Has Been Reduced in Sweden and Norway Since the 1970s

Obstetric Anesthesia Digest ◽

10.1097/01.aoa.0000443360.40801.03 ◽

2014 ◽

Vol 34 (1) ◽

pp. 21-22

Author(s):

U. Waldenström ◽

K. Gottvall ◽

S. Rasmussen

Keyword(s):

Cesarean Section ◽

Maternal Age ◽

Advanced Maternal Age ◽

Nulliparous Women

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Advanced Maternal Age and Adverse Maternal and Neonatal Outcomes in Pregnant Women

Current Women s Health Reviews ◽

10.2174/1573404816999201009160848 ◽

2020 ◽

Vol 16 ◽

Author(s):

Reza Omani-Samani ◽

Saman Maroufizadeh ◽

Nafise Saedi ◽

Nasim Shokouhi ◽

Arezoo Esmailzadeh ◽

...

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Low Birth Weight ◽

Cesarean Section ◽

Pregnant Women ◽

Maternal Age ◽

Unwanted Pregnancy ◽

Advanced Maternal Age ◽

Neonatal Outcomes ◽

Maternal And Neonatal Outcomes

Background: Advanced maternal age is an important predictor for maternal and neonatal outcomes such as maternal mortality, low birth weight, stillbirth, preterm birth, cesarean section and preeclampsia. Objective: To determine the association of advanced maternal age and adverse maternal and neonatal outcomes in Iranian pregnant women. Methods: In this hospital-based cross-sectional study, 5117 pregnant women from 103 hospitals in Tehran, Iran, were participated in the study in 2015. The required data were gathered from hospitals which equipped to the department of obstetrics and gynecology. Advanced maternal age was considered as an independent variable and unwanted pregnancy, preeclampsia, preterm birth, cesarean section and low birth weight were considered as interested outcomes. Results: In our study, the prevalence of advanced maternal age was 12.08%. Advanced maternal age was significantly associated with higher risk of unwanted pregnancy (OR: 1.39, 95% CI: 1.12-1.73), preterm birth (OR: 1.75, 95% CI: 1.28- 2.39) and cesarean section (OR: 1.34, 95% CI: 1.03-1.74). In our study, there was no significant relationship between advanced maternal age and preeclampsia but this relationship could be clinically important (OR: 1.48, 95% CI: 0.99-2.20, P=0.052), and there is no significant relationship between advanced maternal age and low birth weight (OR: 1.08, 95% CI: 0.67-1.74, P=0.736). Conclusion: Advanced maternal age is associated with higher risk of unintended pregnancy, preterm birth and cesarean section but our findings did not support advanced maternal age as a risk factor associated with low birth weight.

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Predictive value of aberrant right subclavian artery for fetal chromosome aneuploidy in women of advanced maternal age

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03626-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Li-Ping Chen ◽

Yong-Feng Lai ◽

Xiao-Hong Zhong ◽

Jian-Hong You ◽

Jiang-Hua Chen ◽

...

Keyword(s):

Subclavian Artery ◽

Maternal Age ◽

Chromosomal Abnormalities ◽

Age Groups ◽

Advanced Maternal Age ◽

Aberrant Right Subclavian Artery ◽

High Prevalence ◽

Ultrasound Findings ◽

Increase Risk ◽

Singleton Pregnancies

Abstract Background In the entire population, an aberrant right subclavian artery (ARSA) is closely associated with chromosomal abnormalities. ARSA with additional ultrasonic findings would increase risk of chromosomal abnormalities. The risk of fetal chromosomal abnormalities increased exponentially with the maternal age. These risks in the advanced maternal age (AMA) group are uncertain. This study aimed to determine the incidence of ARSA in Chinese AMA and non-AMA women and the frequency of aneuploidy among AMA and non-AMA women with ARSA. Methods This retrospective study included 13,690 singleton pregnancies, were divided into AMA and non-AMA groups. Integrated obstetric ultrasonic screening, biochemical screening, noninvasive prenatal screening, and fetal karyotype analysis were analyzed. Results The overall incidence of ARSA was 0.69%, with no difference between age groups. The incidence of chromosomal abnormalities in the AMA group (37 / 2860) was much higher than that of the non-AMA group. The risk of chromosomal abnormalities significantly increased with both ARSA detected and additional ultrasound findings. With combined ARSA and AMA, the likelihood of the incidence of chromosomal abnormalities increased. Chimerism (45X / 46XX) was found with isolated ARSA in AMA pregnancies. Conclusion There is a high prevalence of chromosomal abnormalities in fetuses of AMA women. ARSA increases the risk of chromosomal abnormalities in both age groups, especially combined with ARSA. When ARSA occurs in AMA women, it confers a high likelihood of chromosomal abnormalities.

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Factors associated to the type of childbirth in public and private hospitals in Brazil

Revista Brasileira de Saúde Materno Infantil ◽

10.1590/1806-93042017000300009 ◽

2017 ◽

Vol 17 (3) ◽

pp. 571-580 ◽

Cited By ~ 3

Author(s):

Raphael Mendonça Guimarães ◽

Rafael Leiróz Pereira Duarte Silva ◽

Viviane Gomes Parreira Dutra ◽

Pedro Gomes Andrade ◽

Ana Camila Ribeiro Pereira ◽

...

Keyword(s):

Age Groups ◽

National Health System ◽

Binary Logistic Regression ◽

Positive Association ◽

Public Hospitals ◽

Cesarean Sections ◽

Public And Private ◽

Factors Associated ◽

Public And Private Hospitals ◽

Pregnancy And Birth

Abstract Objectives: to estimate the prevalence of cesarean sections and factors associated to the type of childbirth in Brazil. Methods: data on childbirths were collected in Brazil in 2014. Demographic characteristics, related to pregnancy and birth hospital regime (public or private) were evaluation. For each hypothesis raised, the variables were modeled by the binary logistic regression, which the outcome was considered in the type of childbirth. Results: the prevalence of the cesarean sections in Brazil in 2014 was 52.8%; that is 38.1% at public hospitals and 92.8% at private ones. The association between cesarean section and the legal regime at the hospital was highlighted in the logistic model which presented a positive association and interaction between age groups (OR = 23.26; 95% CI= 13.39 - 41.79 for women between 20 and 24 years old and OR = 51.04; 95% CI 31.06 - 84.23 for women aged 35 and over). Conclusions: the performance of childbirth in Brazil meets the routines and recommendations regarding women's health and humanized childbirth established by the Brazilian National Health System policies.

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Public Service Employee Motivation Issues in Georgia

European Journal of Economics and Business Studies ◽

10.2478/ejes-2018-0005 ◽

2018 ◽

Vol 4 (1) ◽

pp. 49-55

Author(s):

Salome Sakvarelidze

Keyword(s):

Public Service ◽

Employee Motivation ◽

Modern Human ◽

Public And Private ◽

Service Employees ◽

Essential Condition ◽

The Public ◽

Public Managers ◽

Public And Private Sector

Abstract The motivated employee represents the essential condition of any organization’s success. Public and private sector managers should constantly work toward coordinating and increasing employee motivation in order to ensure the timely and effective implementation of the plans set by the organization. Accordingly, proper assessment of processes and prompt determination of individuals’ driving motives are needed. Studies have shown that public service employees from all around the world face challenges, such as: incompatibility of knowledge, experience and position, as well as hard and lightweight work. Consequently, public managers should be aware of modern human resource management methods that can be used in effective and efficient ways to increase employee work quality. The main purpose of the paper is to determine the current situation of the public sector in Georgia. In addition, the research seeks to identify and examine the factors that influence employee demotivation and to determine under what conditions motivation can be a worthwhile investment in a public organizations. Methodologically, the work is based on analysis of the available literature and the results of the research statistically processed based on the survey example of 449 respondents from different Georgian ministries selected by a random simple.

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The implications for advanced maternal age on pregnancy complications and adverse neonatal outcomes

Perinatal Journal ◽

10.2399/prn.21.0293005 ◽

2021 ◽

Vol 29 (3) ◽

pp. 200-209

Author(s):

Zeynep Gedik Özköse ◽

Süleyman Cemil Oğlak

Keyword(s):

Birth Weight ◽

Cesarean Section ◽

Pregnancy Outcomes ◽

Maternal Age ◽

Advanced Maternal Age ◽

Neonatal Outcomes ◽

Apgar Scores ◽

Adverse Neonatal Outcomes ◽

Adverse Pregnancy ◽

Nicu Admission

Objective This study aimed to determine the effect of advanced maternal age (AMA) on maternal and neonatal outcomes in pregnant women aged ≥35 years compared with patients aged 30–34 years. Also, we aimed to analyze the risk estimates of potential confounders to identify whether these variables contributed to the development of adverse pregnancy outcomes or not. Methods This retrospective cohort study included 2284 pregnant women aged ≥35 years at the time of delivery who was delivered in a tertiary referral hospital from January 1, 2016, to December 31, 2020. We further classified these women into two subgroups: 35–39 years as early AMA (EAMA), and ≥40 years as very AMA (VAMA). Pregnancy complications and adverse neonatal outcomes were recorded. Results Compared to younger women, pregnant AMA women had significantly higher risks of complicated pregnancies, including a higher risk of gestational diabetes mellitus (GDM, p<0.001), polyhydramnios (p<0.001), cesarean section (p<0.001), stillbirths (p<0.001), major fetal abnormality (p<0.001), preterm delivery (p<0.001), lower birth weight (p<0.001), lower 5-minute Apgar scores (p<0.001), lower umbilical artery blood pH values (p<0.001), neonatal intensive care unit (NICU) admission (p<0.001), and length of NICU stay (p<0.001). Conclusion We found a strong and significant association between VAMA and adverse pregnancy outcomes, including an increased risk of GDM, polyhydramnios, cesarean section, and adverse neonatal outcomes, including a higher risk of stillbirths, preterm delivery, lower birth weight, lower 5-minute Apgar scores, and NICU admission.

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

PLoS ONE ◽

10.1371/journal.pone.0210655 ◽

2019 ◽

Vol 14 (1) ◽

pp. e0210655 ◽

Cited By ~ 13

Author(s):

Eva Rydahl ◽

Eugene Declercq ◽

Mette Juhl ◽

Rikke Damkjær Maimburg

Keyword(s):

Cesarean Section ◽

Maternal Age ◽

Advanced Maternal Age ◽

Population Register

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Public service motivation in the Chinese public and private sectors

Evidence-based HRM a Global Forum for Empirical Scholarship ◽

10.1108/ebhrm-06-2018-0039 ◽

2019 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Dermot McCarthy ◽

Ping Wei ◽

Fabian Homberg ◽

Vurain Tabvuma

Keyword(s):

Public Service ◽

Public Service Motivation ◽

Economic Sectors ◽

Public And Private ◽

Content Type ◽

Mean Values ◽

The Public ◽

Municipal District ◽

Significant Difference ◽

The Impact

Purpose The purpose of this paper is to statistically test if the public service motivation (PSM) measure operates in the same way across the public and private sectors of a municipal district in China. It also contrasts the relationship between PSM and workplace outcomes across sectors and employee age groups. Design/methodology/approach Survey data from independent samples of public (n=220) and private (n=230) sector employees in the Changsha Municipal District of China is used. The analysis tests for invariance across groups, before comparing mean values and regression weights. Findings Only in respect of one PSM dimension do findings show a significant higher mean in the public sector. No significant difference is found on the impact of PSM on employee performance across sectors, while it is in the private sector that PSM has the greater impact on intention to leave. Findings also show no marked impact of age upon outcomes. Research limitations/implications This study provides an initial set of results and further research will need to be undertaken to verify them. The limited sample size and narrow geographical focus, although in line with similar studies on China, means the ability to draw generalisations is limited. The reliance on self-reported measures means issues with common method bias cannot be ignored. Measures were taken during data collection to minimise issues of bias and a set of post-hoc test results are provided. Practical implications The recruitment of employees with higher levels of PSM can be expected to play a role in achieving better outcomes, regardless of sector and age profile. Originality/value The PSM measure has been applied by researchers across various economic sectors. This paper is one of the first to statistically test if the concept and its measure operates in the same way across sectors. The paper contributes to the on-going debate on PSM in the context of China and its relationship with a number of key output variables. Finally, the paper contributes to the emerging debate on changing workforce demographics and their role in shaping outcomes.

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