Obstetrics and perinatal outcome of adolescent nulliparous pregnant women

OBJECTIVE: To study obstetrics and perinatal outcome in nulliparous teenage singleton pregnancies at a referral teaching hospital in the eastern province of Saudi Arabia. METHOD: All singleton births during 1996-2000 of nulliparous mothers aged < or =17 years at King Fahd University Hospital were reviewed (n = 102) and compared with births of a control group of nulliparous mothers aged 20-24 years who delivered during the same period (n = 102). RESULTS: The incidence of nulliparous teenage pregnancies was 0.8%. As compared with women aged 20-24 years, women of 17 years or less were at higher risk of very preterm birth (p < 0.05). The 5-min Apgar scores were not different between the two groups. Babies born to younger mothers had a significantly lower birth weight than those born to older mothers (p < 0.001); the incidence of a low birth weight (<2,500 g) was significantly lower in the control group (p < 0.04). There were no significant differences in distribution of mode of delivery, admission to the special care baby unit, antenatal complications, cesarean section indications, perinatal mortality rate, and early neonatal complications between the two groups. CONCLUSION: The increase in the very preterm births and the subsequently lower birth weight observed in nulliparous teenage women suggest that the maternal age may be a risk factor for very preterm births and associated long-term hazards.     

Pregnancy outcome at age 40 and older

Objective: Our purpose was to examine pregnancy outcomes among women age 40 or older. Methods: Between January, 1997 and December 1999, we performed a case-control study compared pregnancy outcomes of 468 patients delivered at our hospital at > Or = 40 years old with outcomes in a control group consisting of the next two deliveries of women with ages 20 to 29 years. Retrospective analysis of the antepartum and intrapartum records was done to compare clinical outcome. Results: Approximately 25,356 women delivered during the study period, and 468 (1.8%). Of these women were at age 40 or older. Of this latter group, 50 (10.7%) were nulliparous. Mean birthweight of infants delivered by older nulliparous women was significantly lower than that among nulliparous controls (3210 ± 5 vs. 3320 ± 1 g), whereas mean birth weight in the group of older multiparous was not different than that among younger multiparous controls (3370 ± 1 vs. 3365 ± 4 g). Gestational age at delivery was significantly lower among older nulliparous, and multiparous compared with nulliparous and multiparous younger controls. Older women were at increased risk for cesarean delivery (nulliparous 18%; multiparous 14%) compared with nulliparous and multiparous younger control groups (nulliparous 8%; multiparous 6%). In the study group, the operative vaginal delivery rate was higher than that of the control group. The study groups were more likely to develop gestational diabetes, preeclampsia, and placenta praevia. Older nulliparous had an increased incidence of malpresentation, abnormal labour patterns, special care baby unit admission (SCBU), and low 1-minute Apgar score. Older multiparous were more likely to experience birth asphyxia, premature rupture of membranes, and antepartum vaginal bleeding. Conclusion: Nulliparous women age 40 or over have a higher risk of operative delivery than do youngr nulliparous women. This increase occurs in spite of lower birth weight and gestational age and may be explained by the increase incidence of obstetric complications. Although maternal morbidity was increased in the older women, the overall neonatal outcome did not appear to be affected. Received: 10 May 2000 / Accepted: 26 July 2000     

The perinatal effects of delayed childbearing

OBJECTIVE: To determine if the rates of pregnancy complications, preterm birth, small for gestational age, perinatal mortality, and serious neonatal morbidity are higher among mothers aged 35-39 years or 40 years or older, compared with mothers 20-24 years. METHODS: We performed a population-based study of all women in Nova Scotia, Canada, who delivered a singleton fetus between 1988 and 2002 (N = 157,445). Family income of women who delivered between 1988 and 1995 was obtained through a confidential linkage with tax records (n = 76,300). The primary outcome was perinatal death (excluding congenital anomalies) or serious neonatal morbidity. Analysis was based on logistic models. RESULTS: Older women were more likely to be married, affluent, weigh 70 kg or more, attend prenatal classes, and have a bad obstetric history but less likely to be nulliparous and to smoke. They were more likely to have hypertension, diabetes mellitus, placental abruption, or placenta previa. Preterm birth and small-for-gestational age rates were also higher; compared with women aged 20-24 years, adjusted rate ratios for preterm birth among women aged 35-39 years and 40 years or older were 1.61 (95% confidence interval [CI] 1.42-1.82; P < .001) and 1.80 (95% CI 1.37-2.36; P < .001), respectively. Adjusted rate ratios for perinatal mortality/morbidity were 1.46 (95% CI 1.11-1.92; P = .007) among women 35-39 years and 1.95 (95% CI 1.13-3.35; P = .02) among women 40 years or older. Perinatal mortality rates were low at all ages, especially in recent years. CONCLUSION: Older maternal age is associated with relatively higher risks of perinatal mortality/morbidity, although the absolute rate of such outcomes is low.     

Management of pregnancy complications in women of advanced maternal age

The average age of women at childbirth in high resource obstetric settings has been increasing steadily for approximately 30 years. Women aged 35 years or over have an increased risk of gestational hypertensive disease, gestational diabetes, placenta praevia, placental abruption, perinatal death, preterm labour, fetal macrosomia and fetal growth restriction. Unsurprisingly, rates of obstetric intervention are higher among older women. Of particular concern is the increased risk of antepartum stillbirth at term in women of advanced maternal age. In all maternal age groups, the risk of stillbirth is higher among nulliparous women than among multiparous women. Women of advanced maternal age (>40 years) should be given low dose aspirin in the presence of an additional risk factor for pre-eclampsia and offered serial ultrasounds for fetal growth and wellbeing. Given the increased risk of antepartum stillbirth, induction of labour from 39 weeks’ gestation should be discussed with woman.     

Advanced maternal age

The average age of women at childbirth in industrialised nations has been increasing steadily for approximately 30 years. Women aged 35 years or over have an increased risk of gestational hypertensive disease, gestational diabetes, placenta praevia, placental abruption, perinatal death, preterm labour, fetal macrosomia and fetal growth restriction. Unsurprisingly, rates of obstetric intervention are higher among older women. Of particular concern is the increased risk of antepartum stillbirth at term in women of advanced maternal age. In all maternal age groups, the risk of stillbirth is higher among nulliparous women than among multiparous women. Women of advanced maternal age (>40 years) should be given low dose aspirin (in the presence of an additional risk factor for pre-eclampsia) and offered serial ultrasounds for fetal growth and wellbeing; given the increased risk of antepartum stillbirth, induction of labour from 39 weeks’ gestation should be discussed with the woman.     

Twin gestation in older women: antepartum, intrapartum complications, and perinatal outcomes

Objective: The aim of this study is to present pregnancy and perinatal outcomes of twin gestations in older women and compare them with that for younger women. Study design: We conducted a retrospective cohort study of twin pregnancies in our department between 1988 and 2003. The women were classified into two groups by maternal age: women of age 35 years and older (study group) and women less than 35 years (control group). Population characteristics, complications during pregnancy and delivery, and neonatal outcomes were assessed. The Student’s t-test, χ² test, Fisher exact test, and binary logistic regression analysis were used to examine the relationship between maternal age and the different variables. Results: A total of 238 twin pregnancies were enrolled (study group, 57 women; control group, 181 women). Spontaneous conceptions were significantly higher in the control group (P<0.001), while conceptions after in vitro fertilization (IVF) were significantly higher in study group (P<0.001). Mean figures of gestational age at delivery and birth weight for the older group did not differ significantly from the younger group. Although the antepartum and intrapartum complications were more common in the study group, they were not statistically significant compared to the control group. This was also true for the perinatal outcomes. Only the very low birth weight (VLBW<1,500 g) rate was significantly higher in the study group. The number of perinatal deaths was similar on comparison by maternal age. Conclusions: Based on our study, advanced maternal age at twin gestation does not seem to affect significantly pregnancy complications and perinatal outcomes. VLBW was the only unfavorable perinatal outcome related to advanced maternal age.     

Increased risk in the elderly parturient

PURPOSE OF REVIEW: The steady increase in age in primiparous and multiparous women raises questions concerning increased obstetric risk and outcome in such pregnancies. This review highlights the effects of maternal age on obstetric and perinatal outcome. RECENT FINDINGS: Complications have been associated with increasing maternal age, including abnormal weight gain, obesity, gestational diabetes, chronic and pregnancy-induced hypertension, antepartum haemorrhage, placenta praevia, multiple gestation, prelabour rupture of membranes, and preterm labour. Intrapartum complications of malpresentation, fetopelvic disproportion, abnormal labour, increased use of oxytocin in labour, caesarean section, instrumental delivery, sphincter rupture, and postpartum haemorrhage are more frequent in older women. Advanced maternal age is associated with a higher risk of stillbirth throughout gestation, and the peak risk period is 37-41 weeks. Perinatal outcomes differ with maternal age concerning gestational age, birth weight, prematurity, low birth weight, incidence of small-for-gestational-age infants, fetal distress, and perinatal morbidity and mortality. The increased risk cannot be explained only by intercurrent illness or pregnancy complications. SUMMARY: Increasing maternal age is independently associated with specific adverse outcomes. Increasing age is a continuum rather than threshold effect. More information about obstetric consequences of delayed childbearing is needed both for obstetricians and fertile women.     

The influence of maternal age on pregnancy outcome in nulliparous women with twin gestation

We sought to determine if outcomes of nulliparous twin pregnancies differ based on maternal age. Nulliparous women with current twin pregnancies were identified from a database of women enrolled for outpatient nursing surveillance. Data were stratified into four groups by maternal age: less than 20, 20 to 34, 35 to 39, and greater than or equal to 40 years. Maternal and neonatal outcomes for women less than 20, 35 to 39, and 40 or more were compared with 20- to 34-year-old controls using Kruskal-Wallis, Mann-Whitney, and Pearson chi-square analyses. We analyzed 2144 nulliparous twin pregnancies. Patients ≥35 years (34 to 39, 78.5% or ≥40, 85.9%) were more likely to have cesarean deliveries compared with controls 20 to 34 years old (71.2%). Women aged 35 to 39 were less likely to deliver at <37 weeks, and women in the ≥40 group were less likely to deliver at <35 weeks due to spontaneous preterm labor compared with the controls. Neonates born to women aged 35 to 39 had a greater gestational age at delivery and larger average birth weight than controls. Maternal and neonatal outcomes were not adversely influenced by advanced maternal age in nulliparous women carrying twin gestations.     

Women with placenta praevia and antepartum haemorrhage have a worse outcome than those who do not bleed before delivery.

We set out to assess the maternal and neonatal outcomes of women with placenta praevia and antepartum haemorrhage (APH) between 1991 and 1997, compared with woman with a diagnosed placenta praevia who did not bleed. The demographic data, maternal and perinatal outcomes of 159 women with antepartum haemorrhage were compared with 93 women without antepartum haemorrhage in a retrospective study. Women with antepartum haemorrhage had the diagnosis of placenta praevia confirmed at an earlier gestation. More women with antepartum haemorrhage received antenatal steroids and tocolytic agents, and had emergency caesarean sections. The majority of women with bleeding had an emergency caesarean section for antepartum haemorrhage and more delivered early because of fetal distress. There were more preterm deliveries in women with antepartum haemorrhage. The mean birth weight was 2.69 kg in the women with antepartum haemorrhage and 3.06 kg in those without. More infants in the bleeding group had a low Apgar score at the first minute, respiratory distress syndrome, and admission to special baby care and neonatal intensive care unit. It is concluded that there is an increased risk of premature delivery in women with antepartum haemorrhage and placenta praevia. Aggressive management, tocolysis and cervical cerclage should be explored further to improve the perinatal outcome. Women without antepartum haemorrhage can be managed on an outpatient basis.     

Maternal age ≥45 years and maternal and perinatal outcomes: A review of the evidence

Objective

to examine the evidence in relation to very advanced maternal age (≥45 years) and maternal and perinatal outcomes in high-income countries.

Background

this review was conducted against a background of increasing fertility options for women aged ≥=45 years and rising birth rates among this group of women.

Methods

established health databases including SCOPUS, MEDLINE, CINAHL, EMBASE and Maternity and Infant Care were searched for journal papers, published 2001–2011, that examined very advanced maternal age (VAMA) and maternal and perinatal outcomes. Further searches were based on references found in located articles. Keywords included a search term for maternal age ≥45 years (very advanced maternal age, pregnancy aged 45 years and older) and a search term for maternal complications (caesarian section, hypertension, pre-eclampsia, gestational diabetes) and/or adverse perinatal outcome (preterm birth, low birth weight, small for gestational age, stillbirth, perinatal death). Of 164 retrieved publications, 10 met inclusion criteria.

Data extraction

data were extracted and organised under the following headings: maternal age ≥45 years; maternal characteristics such as parity and use of artificial reproductive technology (ART); and pre-existing maternal conditions, such as diabetes and hypertension. Additional headings included: gestational conditions, such as pre-eclampsia and gestational diabetes (GDM); and perinatal outcomes, including fetal/infant demise; gestational age and weight. Study quality was assessed by using the Critical Appraisal Skills Programme (CASP) guidelines.

Findings

this review produced three main findings: (1) increased rates of stillbirth, perinatal death, preterm birth and low birth weight among women ≥45 years; (2) increased rates of pre-existing hypertension and pregnancy complications such as GDM, gestational hypertension (GH), pre-eclampsia and interventions such as caesarian section; and (3) a trend of favourable outcomes, even at extremely advanced maternal age (50–65 years), for healthy women who had been screened to exclude pre-existing disease.

Key conclusions

although there is strong evidence of an association between very advanced maternal age and adverse maternal and perinatal outcomes, the absolute rate of stillbirth/perinatal death remains low, at less than 10 per 1000 births in most high-income countries. Therefore, although women in this age group encounter greater pregnancy risk, most will achieve a successful pregnancy outcome. Best outcomes appear to be linked to pre-existing maternal health, and pregnancy care at tertiary centres may also contribute. This information should be used to counsel women aged ≥45 years who are contemplating pregnancy.     

The Canadian Perinatal Network: A National Network Focused on Threatened Preterm Birth at 22 to 28 Weeks’ Gestation

ObjectiveThe Canadian Perinatal Network (CPN) maintains an ongoing national database focused on threatened very preterm birth. The objective of the network is to facilitate between-hospital comparisons and other research that will lead to reductions in the burden of illness associated with very preterm birthMethodsWomen were included in the database if they were admitted to a participating tertiary perinatal unit at 22+0 to 28+6 weeks' gestation with one or more conditions most commonly responsible for very preterm birth, including spontaneous preterm labour with contractions, incompetent cervix, prolapsing membranes, preterm prelabour rupture of membranes, gestational hypertension, intrauterine growth restriction, or antepartum hemorrhage. Data were collected by review of maternal and infant charts, entered directly into standardized electronic data forms and uploaded to the CPN via a secure networkResultsBetween 2005 and 2009, the CPN enrolled 2524 women from 14 hospitals including those with preterm labour and contractions (27.4%), short cervix without contractions (16.3%), prolapsing membranes (9.4%), antepartum hemorrhage (26.0%), and preterm prelabour rupture of membranes (23 0%) The mean gestational age at enrolment was 25.9 ± 1.9 weeks and the mean gestation age at delivery was 29.9 ± 5.1 weeks; 57.0% delivered at < 29 weeks and 75.4% at < 34 weeks. Complication rates were high and included serious maternal complications (26 7%), stillbirth (8.2%), neonatal death (16.3%), neonatal intensive care unit admission (60 7%), and serious neonatal morbidity (35 0%)ConclusionThis national dataset contains detailed information about women at risk of very preterm birth. It is available to clinicians and researchers who are working with one or more CPN collaborators and who are interested in studies relating processes of care to maternal or perinatal outcomes.     

Advanced maternal age and adverse perinatal outcomes in an Asian population

Objective

To investigate (1) whether there is an increasing trend in the mean maternal age at the birth of the first child and in the group of women giving birth at age 35 or older, and (2) the association between advanced maternal age and adverse perinatal outcomes in an Asian population.

Study design

We conducted a retrospective cohort study involving 39,763 Taiwanese women who delivered after 24 weeks of gestation between July 1990 and December 2003. Multivariable logistic regression was used to adjust for potential confounding variables.

Results

During the study period, the mean maternal age at the birth of the first child increased from 28.0 to 29.7 years, and the proportion of women giving birth at age 35 or older increased from 11.4% to 19.1%. Compared to women aged 20–34 years, women giving birth at age 35 or older carried a nearly 1.5-fold increased risk for pregnancy complications and a 1.6–2.6-fold increased risk for adverse perinatal outcomes. After adjusting for the confounding effects of maternal characteristics and coexisting pregnancy complications, women aged 35–39 years were at increased risk for operative vaginal delivery (adjusted odds ratio [OR] 1.5, 95% confidence interval [CI] 1.2–1.7) and cesarean delivery (adjusted OR 1.6, 95% CI 1.5–1.7), while women aged 40 years and older were at increased risk for preterm delivery (before 37 weeks of gestation) (adjusted OR 1.7, 95% CI 1.3–2.2), operative vaginal delivery (adjusted OR 3.1, 95% CI 2.0–4.6), and cesarean delivery (adjusted OR 2.6, 95% CI 2.2–3.1). In those women who had a completely uncomplicated pregnancy and a normal vaginal delivery, advanced maternal age was still significantly associated with early preterm delivery (before 34 weeks of gestation), a birth weight <1500 g, low Apgar scores, fetal demise, and neonatal death.

Conclusion

In this population of Taiwanese women, there is an increasing trend in the mean maternal age at the birth of the first child. Furthermore, advanced maternal age is independently associated with specific adverse perinatal outcomes.     

Pregnancy outcomes in urban black South African women aged 35 years and older.

We measured maternal and fetal outcomes for black South African women of age 35 years and above, compared with younger controls. The study was carried out at the Chris Hani Baragwanath Maternity Hospital and the Soweto Community Health Centres, that provide maternity services for urban black pregnant women. This was a retrospective pregnancy cohort, comparing pregnant women aged 35 and above with a control group aged 20-29 years. Early pregnancy losses (<20 weeks) were excluded. There were 1047 women in each arm of the study. Frequencies of hypertension (22.8%), gestational diabetes (0.9%), and prelabour rupture of the membranes (6.9%) were significantly higher for older women. Perinatal mortality rates (42/1000 vs. 33/1000) did not differ significantly. Antepartum admission, induction of labour, caesarean section and neonatal admission were required more frequently in older women. We conclude that pregnancy at age 35 years and above is often difficult and expensive, requiring hospital based interventions to maintain a low perinatal mortality rate.     

Obstetric outcome of teenage pregnancies in North Jordan

Objective: The purpose of this study was to investigate obstetric outcomes of nulliparous teenagers and to compare selected variables of their course and outcome of pregnancy with controls. Methods: A review of hospital records from 1997—1999 was done to compare the obstetric outcome in 760 teenage first pregnancies (study group) with that in control group i.e. 20 years to 29 years selected from the first women in the birth registry who delivered after each study case and satisfying the criteria for controls. Results: Revealed that incidence of complications of pregnancy like anemia, pregnancy induced hypertension and antepartum hemorrhage were similar in study and control groups. Pregnancy weight gain, prelabour rupture of membranes and gestational diabetes were significantly lower among teenage mothers. The normal mode of delivery was commoner in teenagers (89.5%) in comparison to control group (72%), probably because of higher number of low birthweight babies. Although in study group the mean birthweight was lower and the incidence of preterm labour and small for gestational age infants higher, there was also increased incidence of large for gestational age infants. While there was no difference in the types of labour, there were lower caesarean and instrumental deliveries. A statistically non-significant higher incidence of perinatal deaths was observed in teenagers. Conclusions: These results indicated that the course and outcome of pregnancy in teenage mothers had in most respects better obstetric outcomes, despite the higher incidence of preterm labour. Received: 26 May 2000 / Accepted: 26 July 2000     

Advanced maternal age and adverse pregnancy outcomes: A cohort study

ObjectivesTo assess the association between advanced maternal age and adverse perinatal outcomes in single pregnancies.Materials and methodsA cohort study was conducted using data from 27,455 singleton births attended at our hospital between 2007 and 2018. Three maternal age groups were established, and perinatal outcomes were compared between-groups (<35 years (n = 19,429; 70.7%), 35–40 years (n = 7189; 26.2%), and >40 years (n = 846; 3.1%). The data were compared using chi-square analysis and the results were adjusted using a logistic regression model. Decision trees were designed to examine the fetal mortality and caesarean section variables. We used the SPSS 23 statistical software program for the statistical analysis.ResultsThe mean age of the women was 31.21 years. No differences were found associated with age for neonatal acidosis, an Apgar score <7 at 5 min after birth, threatened preterm labour, preterm rupture of membranes, or high-grade perineal tear. The analyses found statistically significant increases in the rates of hypertensive disorders, diabetes mellitus, induction of labour, and caesarean section, after 35 years of age. The risks of fetal death, neonatal admission, small for gestational age, placenta previa, instrument delivery, maternal ICU admission, and postpartum haemorrhage were greater after 40 years of age.ConclusionsThe results of our study indicated that women >35 years of age had worse perinatal outcomes, compared with younger women. This finding was more evident in patients >40 years of age, which highlighted the greater risk of fetal death and serious maternal complications in this group.     

Maternal and perinatal outcome of pregnancies after the age of 45

OBJECTIVE: To describe the maternal and perinatal outcome of pregnancies in women aged 45 years or more at the time of delivery and to compare them with pregnancies in women aged between 20 and 29 years. METHODS: A retrospective review of hospital deliveries after 28 weeks gestation was performed at the Princess Badeea Teaching Hospital in North Jordan for patients delivered between 1st April 1994 and 31st December 1997. We compared the maternal and perinatal outcome of pregnancies in women aged of 45 years or more (study group, n = 114) with women aged between 20-29 years (control group, n = 121) delivered at the same hospital during the same period. RESULTS: The incidence of pregnant women aged 45 years or more was 3.3 per 1,000 births. The median maternal age was 45 years. The majority of women (81.6%) were 45 to 46 years old. Gravidity and parity was significantly higher in the study group (p < 0.0001), also antenatal and medical complications as pre-eclampsia and diabetes mellitus were higher in the study group. Caesarean section rate, incidences of placental abruption and placenta previa were more common in older patients compared with young patients (32.4 vs 10.7%, 6.1 vs 0.8% and 4.4 vs 1.6%, respectively). There were no differences in the incidences of neonatal deaths, lethal malformations and fetal weight between the 2 groups. CONCLUSION: Women aged 45 years or more at delivery may expect a good pregnancy outcome but should expect a higher incidences of placental abruption, placenta previa, preeclampsia and caesarean delivery.     

Outcome of twin pregnancies after assisted reproductive techniques--a comparative study

OBJECTIVE: To compare obstetrical and perinatal outcome of twin pregnancies after assisted reproductive techniques (ART) with that of twins conceived spontaneously. STUDY DESIGN: Hospital based retrospective study. RESULTS: There were 132 twin deliveries of which 36 were conceived after ART. Patients of the ART group were mostly nulliparous and slightly older. There was no statistically significant difference in the frequency of preterm delivery or mean gestational age at delivery. Elective Caesarean delivery was more frequent in twin pregnancies conceived after ART, and there were no other differences in maternal complications. There was also no difference in the mean birth weight or frequency of neonatal complication between the two groups. CONCLUSION: In this comparative study, the obstetric and neonatal outcomes between spontaneous twins and those conceived after ART are similar except for higher operative deliveries in the latter group of twins.     

Obstetric outcomes in nulliparous women aged 35 and over with dichorionic twin pregnancy

The aim of this study is to investigate maternal and neonatal outcomes in dichorionic twins to nulliparous women older than 35 compared to those of their younger counterparts. This was a retrospective study of dichorionic twin pregnancies managed at Japanese Red Cross Katsushika Maternity Hospital between 2002 and 2006. Nulliparous women 35 years and older at delivery (n = 60) were compared with nulliparous women between the ages of 20 and 29 at delivery (n = 71). The women ≥ 35 year old were more likely to have used assisted reproductive technology. There were no measurable differences in obstetric outcomes such as preeclampsia, premature delivery, low birth weight and neonatal asphyxia between the two pregnancies. Advanced maternal age does not seem to affect obstetric outcomes in nulliparous dichorionic twin pregnancies.     

Understanding perinatal mortality

The term perinatal death is used to describe antepartum and intrapartum stillbirths, and early neonatal deaths. At term, intrapartum stillbirth and neonatal death are collectively referred to as delivery related perinatal death, and the incidence in nulliparous and multiparous women is approximately one in 1000 and one in 2000 births, respectively. Associated factors include advanced maternal age, small for gestational age, fetal macrosomia, breech labour and previous caesarean delivery. The impact of obstetric interventions in labour on delivery related perinatal death, including rising rates of caesarean delivery, is complex and unclear. The incidence of overall perinatal death is falling mainly as a result of improvements in the management of premature neonates and from decreased deaths secondary to intrapartum anoxia at term. This review will provide an overview of perinatal mortality with a particular emphasis on delivery related perinatal death at term.     

Pregnancy outcome in primiparae of advanced maternal age

OBJECTIVE: To investigate the impact of maternal age on singleton pregnancy outcome, taking into account intermediate and confounding factors. STUDY DESIGN: In this population-based retrospective cohort study, perinatal data of primiparous women aged 35 years or more (n = 2970), giving birth to a singleton child of at least 500 g, were compared to data of primiparous women aged 25-29 years old (n = 23,921). Univariate analysis was used to assess the effect of maternal age on pregnancy outcomes. The effects of intermediate (hypertension, diabetes and assisted conception) and confounding factors (level of education) were assessed through multivariable logistic regression analysis. RESULTS: Older maternal age correlated, independently of confounding and intermediate factors, with very preterm birth (gestational age <32 weeks) [adjusted odds ratio (AOR) 1.51, 95% confidence intervals (CI) 1.04-2.19], low birth weight (birth weight <2500 g) (AOR 1.69, 95% CI 1.47-1.94) and perinatal death (AOR 1.68, 95% CI 1.06-2.65). CONCLUSION: Maternal age is an important and independent risk factor for adverse pregnancy outcome.