scholarly journals Does advanced maternal age influence obstetric outcome: a study in a tertiary care centre

2019 ◽  
Vol 8 (4) ◽  
pp. 1313
Author(s):  
Jose C. V. ◽  
Lissiamma George ◽  
Sunitha Sukumaran
Keyword(s):  
High Risk ◽  
Gestational Diabetes ◽  
Maternal Age ◽  
Tertiary Care ◽  
Advanced Maternal Age ◽  
Chronic Hypertension ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Younger Women ◽  
Medical Disorders

Background: Advanced maternal age defined as age 35 years and older at estimated date of delivery has become increasingly common in last two to three decades. The International Federation of Gynaecology and Obstetrics in 1958 recommended that all women going through their first pregnancy over the age of 35 years should be considered high risk for pregnancy and included in this category 1.Methods: A one-year prospective observational study conducted in a tertiary care hospital after institutional ethical clearance. All 165 women above 35yrs who delivered during this period were taken as Cohort 1. Same number of women aged between 20 and 34 years were randomly selected as comparison group (Cohort 2). Both the groups were compared in terms of preexisting medical disorders, obstetrical morbidities, antenatal complications, intrapartum complications.Results: Older and younger women had similar antenatal booking, occupational and socioeconomic status. The main reason for pregnancy at advanced age group was late marriage. The risk of chronic hypertension, gestational diabetes mellitus, pre-existing medical disorders were higher in advanced maternal age.Conclusions: Increasing maternal age is associated with elevated risks for pregnancy complications. They are at high risk for gestational diabetes, cesarean section and to have low birth weight babies. Since these women are at higher risk of complications, they should be advised to adhere to frequent antenatal visits and close supervision.

Study of Fetomaternal Outcome in Elderly Pregnancy in Tertiary Care Center, Kakinada

2021 ◽  
Vol 8 (38) ◽  
pp. 3360-3365
Author(s):  
Akkamamba Basa ◽  
Srujana Palavalasa ◽  
Geetasree Vanapalli
Keyword(s):  
High Risk ◽  
Gestational Diabetes ◽  
Preterm Delivery ◽  
Maternal Age ◽  
Elderly Women ◽  
Care Center ◽  
Tertiary Care ◽  
Advanced Maternal Age ◽  
Tertiary Care Centre ◽  
Fetal Complications

BACKGROUND Advanced maternal age generally signifies age after 35 years at the time of delivery. Maternal age is an important determinant of the outcome of pregnancy. Elderly women are at a high risk of several complications like abortion, ectopic pregnancy, preterm labour, hypertension, gestational diabetes, malpresentation and instrumental deliveries. Older the women, higher the fetal complications like Downs syndrome, preterm baby, low birth weight (LBW) babies and intrauterine growth restriction (IUGR). The purpose of this study was to assess the fetomaternal outcome in elderly pregnancy at a tertiary care centre. METHODS This study was a prospective hospital-based study of 100 elderly pregnant women aged 35 years and above admitted in OBG Department, Government General Hospital, Kakinada, Andhra Pradesh, from June 2020 to May 2021. The labor ward register and case records were used for all elderly gravida women admitted and delivered and details of these patients was recorded in the proforma. RESULTS In this study, 68 % were in 35 - 37 years, 32 % were in 38 - 40 years age group. 36 % were primigravida and 64 % were multigravida. 76 % women were housewives and 24 % women were employed. 32 % of women had history of previous abortions. Hypertensive disorders were observed in 42 % of patients, gestational diabetes was observed in 28 % of patients, antepartum haemorrhage was observed in 24 % of patients, IUGR was noted in 20 % of patients and preterm delivery was noted in 10 % of patients. 46 % of patients were delivered by vaginal route and 40 % of patients were delivered by caesarean section. 7.69 % were intrauterine devices (IUDs), 3.85 % had congenital anomalies. CONCLUSIONS Elderly women are at a high risk of developing several maternal and fetal complications. Many of these complications can be successfully managed with improved health services, pre-conceptional counselling and frequent antenatal visits. KEYWORDS Advanced Maternal Age, Maternal Complication, Caesarean, Preterm Delivery

scholarly journals Impact of aging on obstetric outcomes: defining advanced maternal age in Barcelona

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Marta Claramonte Nieto ◽  
Eva Meler Barrabes ◽  
Sandra Garcia Martínez ◽  
Mireia Gutiérrez Prat ◽  
Bernat Serra Zantop
Keyword(s):  
Risk Factor ◽  
Gestational Diabetes ◽  
Maternal Age ◽  
Placenta Previa ◽  
Significant Risk ◽  
Advanced Maternal Age ◽  
Obstetric Outcomes ◽  
Chronic Hypertension ◽  
Mediterranean Population ◽  
Confounding Factors

Abstract Background Women of advanced maternal age (AMA) are a growing population, with higher obstetric risks. The Mediterranean population has specific characteristics different from other areas. Thus, the objective of this study was to establish a cut-off to define AMA in a selected mediterranean population coming from a tertiary referral private/mutual health hospital in Barcelona. Methods Retrospective cohort of euploid singleton pregnancies delivered from January 2007 to June 2017. Main maternal outcomes were: gestational diabetes, preeclampsia, placenta previa, c-section and prolonged hospitalization (≥ 7 days). Main adverse perinatal outcomes were: stillbirth, prematurity, preterm prelabor rupture of membranes, low birth weight, need of admission at a neonatal intensive care unit and perinatal mortality. Adjustment for confounding factors (smoking, previous comorbilities, parity, assisted reproductive techniques (ART) and obesity) was performed. Results A total of 25054 pregnancies were included. Mean maternal age was 34.7 ± 4.2 years, with 2807 patients in the group of age between 40 and 44 years (11.2%) and 280 patients ≥45 years (1.1%). Women at AMA had higher incidence of previous comorbilities (compared to the reference group of women < 30 years): prior c-section, chronic hypertension and obesity. In addition, they were more likely to use ART. After adjusting for confounding factors, maternal age was an independent and statistically significant risk factor for gestational diabetes (OR 1.66/2.80/3.14) for ages 30–39, 40–44 and ≥ 45 years respectively, c-section (OR 1.28/2.41/7.27) and placenta previa (OR 2.56/4.83) for ages 40–44 and ≥ 45 years respectively, but not for preeclampsia (neither early-onset nor late-onset). Risk of emergency c-section was only increased in women ≥45 years (OR, 2.03 (95% CI, 1.50–2.74). In the other groups of age, the increase in c-section rate was because of elective indications. Age ≥ 45 years was associated with iatrogenic prematurity < 37 weeks (OR 2.62, 95% CI 1.30–5.27). No other relevant associations between AMA and maternal or neonatal outcomes were found. Conclusions Maternal age is an independent risk factor for adverse obstetric outcomes. Age ≥ 40 years was associated to relevant increased risks and reveals to be an adequate cut-off to define AMA in our population.

A Retrospective Study of Pemphigus in a Tertiary Care Centre in South India

2021 ◽  
Vol 8 (31) ◽  
pp. 2913-2918
Author(s):  
Simon Sheena Ann
Keyword(s):  
Histopathological Examination ◽  
Demographic Data ◽  
Tertiary Care ◽  
Immunosuppressive Treatment ◽  
Care Hospital ◽  
Age Group ◽  
Tertiary Care Centre ◽  
Medical Disorders ◽  
Autoimmune Bullous Diseases ◽  
Mucosal Involvement

BACKGROUND Pemphigus is a group of rare, life-threatening autoimmune bullous diseases of the skin and mucosa which result in intraepidermal blistering. Associated autoimmune conditions and the extensive mucocutaneous detachment impair the quality of life. Immunosuppressive treatment adds to the morbidity in patients. We wanted to assess the clinical presentation of pemphigus among the study subjects along with the outcome of pemphigus patients with the extent of the disease and results of pus culture. METHODS Retrospective analysis of case records of patients with pemphigus in a tertiary care hospital during a period of 3 years was done in 2015. Demographic data, clinical findings, underlying medical disorders, details of deaths, investigation reports and treatment details were recorded. RESULTS Common age group affected was 51-60 years (31.5 %) among a total of 54 pemphigus patients. There were 26 males and 28 (51. 9 %) females and in majority of the patients (44.4 %) duration was less than 6 months. Out of 47 patients, oral mucosal involvement was grade 1 in 20 (37 %) cases, grade 2 in 12 (22.2 %) and in 15 (27.8 %) patients it was grade 3.Histopathological examination showed suprabasal cleft in 82.1 %, subcorneal blister in 5.7 %, acantholytic cells in 48.6 % and row of tombstone appearance in 9.4 %. Out of 36 patients, DIF test reported intercellular IgG in 65 % and C3 in 50 % .Diabetes was found in 14 (25.9 %), candidiasis in 12 (22.2 %), thyroid disease in 6 (11.1 %) and hypertension in 3 patients. Three patients died. Among 10 patients with more than 30 % body surface area involvement, 1 (10 %) patient died. Two (13 %) deaths occurred among 15 patients in whom pus C&S was positive. CONCLUSIONS Pemphigus patients were of slightly higher (51 - 70 years) age group and the 3 patients died were females. Autoimmune disorders like diabetes and thyroid disorders were found among many patients and their family members. Infection could be an important cause of death, but no statistically significant association was found in the present study. KEYWORDS Pemphigus, Steroids, Comorbidity, Deaths

scholarly journals Analysis of maternal mortality at tertiary care centre

2021 ◽  
Vol 10 (12) ◽  
pp. 4454
Author(s):  
Hemalatha S. V. ◽  
Manickadevi M. S.
Keyword(s):  
High Risk ◽  
Maternal Mortality ◽  
Early Identification ◽  
Tamil Nadu ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Live Births

Background: The aim of the study was to analyse the causes of maternal mortality at a tertiary care centre and find measures to reduce it.Methods: A retrospective study of maternal deaths from January 2018 to December 2020 that occurred at Government Vellore Medical College and Hospital, a tertiary care hospital in Tamil Nadu. Data collected from case records and death reviews.Results: There was total of 71 deaths at the tertiary care hospital during the period January 2018 to December 2020 out of 31407 live births giving Maternal mortality rate of 226/1,00,000 live births. The MMR is high as it is a tertiary hospital catering referral from six districts. Most of the cases were due to late referrals. The majority of the deaths occurred in primigravida (50.7%), in the age group of 21 to 25 years (35.2%) and around term gestational age (49.3%). The most common cause of death in our study was hypertensive disorders of pregnancy (29.5%) followed by PPH (14.08%).Conclusions: From our study we concluded that the most common causes of maternal death were due to direct obstetric causes like severe pre-eclampsia, eclampsia and post-partum haemorrhage. Early identification of high-risk cases, early identification of GHT, anaemia and its correction, early referral of high-risk cases to tertiary centre can prevent most of the deaths. 

scholarly journals Comparison of pregnancy outcomes between women of advanced maternal age (≥35 years) versus younger women in a tertiary care center in Saudi Arabia

2021 ◽  
Vol 41 (5) ◽  
pp. 274-279
Author(s):  
Taghreed Shams ◽  
Tala Gazzaz ◽  
Khalda Althobiti ◽  
Nouf Alghamdi ◽  
Waleed Bamarouf ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Sample Size ◽  
Cesarean Delivery ◽  
Maternal Age ◽  
Tertiary Care ◽  
Advanced Maternal Age ◽  
Small Sample ◽  
Cross Sectional ◽  
Neonatal Complications ◽  
Younger Women

BACKGROUND: Pregnancy in women aged 35 years or above is generally considered an advanced maternal age (AMA). AMA is associated with an increased rate of maternal and neonatal complications. OBJECTIVES: Assess the effect of AMA on maternal and neonatal outcomes. DESIGN: Analytical cross-sectional study of medical records. SETTINGS: In-patient hospital tertiary care setting in Jeddah. PATIENTS AND METHODS: All women who attended antenatal care and delivered at King Abdulaziz Medical City in Jeddah in the first half of 2018 were included in the study. Outcomes for women 35 years of age or older were compared with younger women. Significant factors in a univariate analysis were entered in a multiple logistic regression model to assess the association between AMA and outcomes. MAIN OUTCOME MEASURES: Rates of maternal neonatal complications, analysis of factors associated with advanced maternal, gestational diabetes mellitus (GDM), cesarean delivery. SAMPLE SIZE: 1586 women. RESULTS: Of the 1586 women, 406 were 35 years of age or older (25.6%), and 1180 were younger than 35 years. The AMA group had a significantly higher proportion of GDM (32.0% versus 13.2%, P <.001). The adjusted odds ratio (OR) for GDM was 2.6 (95% CI 2–3.5, P <.001.) compared with younger women in the multivariate logistic regression analysis. Older women had a higher rate of cesarean delivery (43.6% versus 30.8%, P <.001). The adjusted OR for cesarean vs. vaginal delivery was 1.5 (CI 1.2–1.9, P =.002). CONCLUSION: Pregnancy in women 35 years or older was associated with an increased risk of GDM and cesarean delivery. LIMITATIONS: Cross-sectional design, small sample size, single hospital. CONFLICT OF INTEREST: None.

scholarly journals Maternal and foetal outcome in preterm births in a rural tertiary care centre: a retrospective study

2021 ◽  
Vol 11 (1) ◽  
pp. 50
Author(s):  
Deeksha Rao M. ◽  
Vasantha Kumar S.
Keyword(s):  
Retrospective Study ◽  
Preterm Birth ◽  
Tertiary Care ◽  
Preterm Births ◽  
Morbidity And Mortality ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Mortality And Morbidity ◽  
Medical Disorders ◽  
Nicu Admission

Background: Preterm birth (PTB) is one of the main causes of perinatal mortality and morbidity. It can also result in long term health consequences for both mother and the newborn. The objective was to assess maternal and fetal morbidity and mortality in PTBs.Methods: A retrospective study was done in the department of obstetrics and gynecology in a tertiary care hospital during January 2020 and June 2020. Ninety-three women with records of preterm births were analyzed for maternal and fetal outcomes. coGuide statistical software was used for data analysis.Results: 48.39% of the women were between 20 to 24 years of age. The majority (50.54%) were primigravida. The main causes for PTB among the study participants were medical disorders (39.78%), PPROM (29.03%), spontaneous labor without any underlying cause (18.28%). 51.61% had a vaginal delivery, 88.17% had a live birth. The majority of 52 (55.91%) neonates had birth weights between 1.51 to 2.5 kg. Fifty-nine neonates (63.44%) needed NICU admission. The reason for NICU admission in majority 25 (26.88%) was respiratory distress.Conclusions: Timely, early diagnosis and treatment of medical disorders among antenatal women can aid in reducing the occurrence of preterm births and their associated morbidity and mortality. Medical disorders and premature preterm rupture of membrane remain the main causes of preterm birth. 

scholarly journals Use of monoclonal antibody therapy for nosocomial SARS-CoV-2 infection in patients at high risk for severe COVID-19: experience from a tertiary-care hospital in Germany

Infection ◽  
2021 ◽  
Author(s):  
Johanna Koehler ◽  
Barbara Ritzer ◽  
Simon Weidlich ◽  
Friedemann Gebhardt ◽  
Chlodwig Kirchhoff ◽  
...  
Keyword(s):  
High Risk ◽  
Tertiary Care Hospital ◽  
Severe Disease ◽  
Treatment Options ◽  
Tertiary Care ◽  
Antibody Therapy ◽  
Additional Treatment ◽  
Care Hospital ◽  
Cross Sectional ◽  
Asymptomatic Patients

AbstractAdditional treatment options for coronavirus disease (COVID-19) are urgently needed, particularly for populations at high risk of severe disease. This cross-sectional, retrospective study characterized the outcomes of 43 patients with nosocomial severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection with and without treatment using monoclonal SARS-CoV-2 spike antibodies (bamlanivimab or casirivimab/imdevimab). Our results indicate that treatment with monoclonal antibodies results in a significant decrease in disease progression and mortality when used for asymptomatic patients with early SARS-CoV-2 infection.

scholarly journals Efficiency of non-invasive prenatal screening in pregnant women at advanced maternal age

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hui Zhu ◽  
Xiaoxiao Jin ◽  
Yuqing Xu ◽  
Weihua Zhang ◽  
Xiaodan Liu ◽  
...  
Keyword(s):  
High Risk ◽  
Pregnant Women ◽  
Predictive Value ◽  
Trisomy 21 ◽  
Maternal Age ◽  
Prenatal Screening ◽  
Advanced Maternal Age ◽  
Youden Index ◽  
Non Invasive ◽  
Sensitivity Specificity

Abstract Background Non-invasive prenatal screening (NIPS) is widely used as the alternative choice for pregnant women at high-risk of fetal aneuploidy. However, whether NIPS has a good detective efficiency for pregnant women at advanced maternal age (AMA) has not been fully studied especially in Chinese women. Methods Twenty-nine thousand three hundred forty-three pregnant women at AMA with singleton pregnancy who received NIPS and followed-up were recruited. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), receiver operating characteristic (ROC) curves and the Youden Index for detecting fetal chromosomal aneuploidies were analyzed. The relationship between maternal age and common fetal chromosomal aneuploidy was observed. Results The sensitivity, specificity, PPV, NPV of NIPS for detecting fetal trisomy 21 were 99.11, 99.96, 90.98, and 100%, respectively. These same parameters for detecting fetal trisomy 18 were 100, 99.94, 67.92, and 100%, respectively. Finally, these parameters for detecting trisomy 13 were 100, 99.96, 27.78, and 100%, respectively. The prevalence of fetal trisomy 21 increased exponentially with maternal age. The high-risk percentage incidence rate of fetal trisomy 21 was significantly higher in the pregnant women at 37 years old or above than that in pregnant women at 35 to 37 years old. (Youden index = 37). Conclusion It is indicated that NIPS is an effective prenatal screening method for pregnant women at AMA.

scholarly journals Extended embryo culture is effective for patients of an advanced maternal age

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
R. Sainte-Rose ◽  
C. Petit ◽  
L. Dijols ◽  
C. Frapsauce ◽  
F. Guerif
Keyword(s):  
Live Birth ◽  
Embryo Culture ◽  
Maternal Age ◽  
Chromosomal Abnormalities ◽  
Inner Cell Mass ◽  
Cell Mass ◽  
Advanced Maternal Age ◽  
Birth Rates ◽  
Younger Women ◽  
Live Birth Rates

AbstractThe aim of this study was to determine the effectiveness of extended embryo culture in advanced maternal age (AMA) patients (37–43 years). In this retrospective analysis, 21,301 normally fertilized zygotes from 4952 couples were cultured until the blastocyst stage. Blastocyst development, including kinetics and morphology, transfer rate, implantation and live birth rates, were measured. In AMA patients, the blastocyst rate was significantly decreased as compared to that in younger women. On day 5, blastocysts underwent growth retardation in AMA patients, which was highlighted by a decreased rate of full/expanded blastocysts. Organization of the cells (trophectoderm and inner cell mass) was unaffected by age. However, in AMA patients, a ‘good’ morphology blastocyst had a decreased probability to implant compared with an ‘average’ morphology blastocyst in younger women. While the rates of blastocyst transfer and useful blastocysts were similar to younger patients, in AMA patients, both implantation and live birth rates were significantly reduced. Our results support the idea that extended embryo culture is not harmful for AMA patients. However, embryo selection allowed by such culture is not powerful enough to avoid chromosomal abnormalities in the developed blastocysts and therefore cannot compensate for the effect of a woman’s age.

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