La edad materna como factor de riesgo obstétrico. Resultados perinatales en gestantes de edad avanzada

Objective

To compare perinatal outcomes in women aged 35 years or over with those in a control group aged less than 35 years.

Design

Historical cohort study.

Setting

Valladolid (Spain).

Methods

Univariate analysis was performed with estimation of relative risks (RR). Variables related to epidemiology, pregnancy course and perinatal outcomes were analyzed.

Results

A total of 1,455 deliveries were analyzed, of which 355 involved women aged 35 years or over (24.39%). Older women more frequently showed pregnancy-associated disorders (29.2 vs 15.8%, p < 0.001): gestational diabetes (6.2%, p < 0.0029), first-trimester metrorrhagia (5.6%, p < 0.01), and risk of preterm birth (3.9%, P < 0.007); pregnancy-induced hypertension was also more frequent in this group but this difference was not statistically significant. Induction of labor was more frequently required in the older group (RR = 1.42; 95% CI:1.08-1.87). Cesarean section was required in 47% of older nulliparous women (RR = 1.63; 95% CI: 1.24-2.15). The overall perinatal mortality rate in older patients was 16.5‰, compared with 2.77‰ in the control group. Maternal morbidity was higher in the group of older patients (RR 5.98; 95% CI 1.35-26.54) and mainly consisted of hemorrhagic complications.

Conclusions

Advanced maternal age is associated with a higher frequency of pregnancy-related disorders and a greater incidence of medically-induced delivery and cesarean sections, especially in primiparous mothers. Age therefore influences maternal and fetal morbidity and mortality. Consequently, these women constitute an obstetric risk population requiring special attention which, given the number of older pregnant women, goes beyond the scope of health provisions in our environment.     

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.     

The Effect of Maternal Age on Adverse Birth Outcomes: Does Parity Matter?

ObjectivesTo examine the effect of parity on the association between older maternal age and adverse birth outcomes, specifically stillbirth, neonatal death, preterm birth, small for gestational age, and neonatal intensive care unit admission.MethodsWe conducted a retrospective cohort study of singleton births in British Columbia between 1999 and 2004. In the cohort, 69 023 women were aged 20 to 29, 25 058 were aged 35 to 39, and 4816 were aged 40 and over. Perinatal risk factors, obstetric history, and birth outcomes were abstracted from the British Columbia Perinatal Database Registry. Logistic regression was used to calculate adjusted odds ratios (aOR) and 95% confidence intervals for adverse outcomes in the two older age groups compared with the young control subjects.ResultsCompared with younger control subjects, women aged 35 to 39 years had an aOR of stillbirth of 1.5 (95% CI 1.2 to 1.9) and women aged ≥ 40 years also had an aOR of 1.5 (95% CI 1.0 to 2.4). The aOR for NICU admission was 1.2 (95% CI 1.0 to 1.3) in women aged 35 to 39 years and 1.4 (95% CI 1.1 to 17) in women aged ≥ 40 years compared with younger control subjects. The risk of preterm birth and SGA differed by parity. The aOR for preterm birth compared with younger primiparas was 1.5 (95% CI 1.4 to 1.7) for women aged 35 to 39 years and 1.6 (95% CI 1.3 to 2.0) for women aged ≥ 40 years. In multiparas the aOR for preterm birth was 1.1 (95% CI 1.1 to 1.2) in women aged 35 to 39 and 1.3 (95% CI 1.1 to 1.5) in women > 40 years. The aOR for SGA in primiparas was 1.2 (95% CI 1.1 to 1.4) for women aged 35 to 39 and 1.4 (95% CI 1.1 to 1.7) for women aged ≥ 40 years. The risk of neonatal death was not significantly different between groups.ConclusionOlder women were at elevated risk of stillbirth, preterm birth, and NICU admission regardless of parity. Parity modified the effect of maternal age on preterm birth and SGA. Older primiparas were at elevated risk for SGA, but no association between age and SGA was found in multiparas. Older primiparas were at higher risk of preterm birth than older multiparas compared with younger women.     

Advanced maternal age and fetal growth inhibition in triplets

OBJECTIVE: To determine whether advanced maternal age is associated withfetal growth inhibition in triplets. STUDY DESIGN: We conducted a retrospective cohort study on triplet live births in the United States from 1995 through 1998. The outcomes of fetal growth inhibition measured were low birth weight, very low birth weight, preterm birth, very preterm birth and smallnessfor gestational age. We generated adjusted ORs after taking into account intracluster correlations using the generalized estimating equation framework. RESULTS: As compared to women of younger maternal age (20-29), mature (30-39) and older women (> or =40 years) with triplet gestations tended to have a lower likelihood offetal growth inhibition. Mean birth weight and mean gestational age at delivery increased with increasing maternal age in a dose-dependent pattern (p for trend < 0.0001). As compared to triplets born to younger mothers, those of older women were less likely to have low birth weight (OR=0.51, 95% CI=0.37-0.69) or very low birth weight (OR = 0.58, 95% CI = 0.47-0.72) or to be preterm (OR = 0.39, 95% CI = 0.27-0.56) or very preterm (OR = 0.67, 95% CI = 0.55-0.80). The riskfor small-for-gestational-age infants was comparable. CONCLUSION: Older maternal age is associated with morefavorable triplet fetal growth parameters, although the exact mechanisms of this paradox remain poorly understood.     

Perinatal outcome of pregnancies complicated by vaginal bleeding.

OBJECTIVE: To examine the effect of first and/or second trimester vaginal bleeding on pregnancy outcome. DESIGN: A prospective one-year birth cohort. SETTING: Two northernmost administrative districts of Finland. PATIENTS: 8718 singleton pregnancies, of whom 807 (9.3%) reported bleeding during the first (601) and/or second trimester (206); light bleeding in 595 cases and heavy bleeding in 212. The remaining 7911 women served as a reference group. MAIN OUTCOME MEASURES: Low birth weight rate (LBW), preterm birth rate, congenital malformations and perinatal mortality rate. RESULTS: Bleeding was most frequent in women of more advanced age (> or = 35 years old), with previous miscarriages, with infertility problems or using an IUCD prior to the pregnancy. Parity, smoking and social status were not associated with bleeding. Caesarean section rate and placental complications during the third trimester and at delivery were more common among the bleeders than in the reference group. The LBW rate was three-fold among the bleeders and the preterm birth rate two-fold. The risk (OR) of a LBW infant among second trimester bleeders was 4.1 (95% CI 2.6-6.4), that of preterm birth 2.9 (95% CI 1.9-4.6), and that of congenital malformations 2.9 (95% CI 1.7-4.7). No association existed between bleeding and perinatal mortality. CONCLUSIONS: Bleeding during the second trimester indicates a poor pregnancy outcome and an increased risk of LBW, and preterm birth and/or congenital malformation.     

Maternal and perinatal outcome in nulliparous women aged 35 and older

OBJECTIVE: To compare the maternal and perinatal outcome of nulliparous women 35 years and older at the time of delivery with nulliparous women 25-29 years old. METHODS: A retrospective review of maternal and newborn records of singleton gestations only for first birth in women aged 35 and older (study group n = 143) were compared with pregnancies of women aged 25-29 (control group, n = 148) delivered at the same period with respect to pregnancy complications and outcome. The study was performed at the Princess Badeea Teaching Hospital in North Jordan between January 1, 1996 and July 1, 2000. RESULTS: Most of the elderly nulliparous women were professionals (60%) and 20% had a history of infertility. Compared with women aged 20-29 years, women delivering their first child at or >35 years were at increased risk of weight gain, obesity, chronic and pregnancy-induced hypertension, antepartum haemorrhage, multiple gestation, malpresentation, and premature rupture of membranes. Women aged 35 years and older were also substantially more likely to have preterm labour, oxytocin use, and caesarean births. The older women differed significantly in neonatal outcomes: gestational age, birth weight, preterm delivery, low birth weight, small for gestational age, fetal distress and neonatal intensive care unit admissions. CONCLUSION: It is concluded that nulliparous women 35 years and older had higher risk of antepartum, intrapartum, and neonatal complications than nulliparous women aged 25-29 years, but these risks, for the most part, are manageable in the context of modern obstetrics. The excess rate of caesarean sections is only partially accounted for by gestational complications. Despite the increased risk of complications, perinatal death of the study group was similar to that of the control group. There were no maternal deaths.     

Obstetric risks of pregnancy in women less than 18 years old

OBJECTIVE: To quantify the age-related risks of adverse outcome during pregnancy in women less than 18 years old. METHODS: We analyzed data from 341,708 completed singleton pregnancies in the North West Thames region between 1988 and 1997. Pregnancy outcomes were compared by age at delivery in women less than 18 years old (n = 5246) and 18-34 years old (n = 336,462); women 35 years old or older (n = 48,658) were excluded. Data are presented as percentages of women less than 18 and 18-34-year-old women, with adjusted odds ratios (OR) and 99% confidence intervals (CI). RESULTS: Pregnancy in women less than 18 years old was associated with increased risk of preterm labor before 32 weeks' gestation (OR 1.41, CI 1.02, 1.90), maternal anemia (OR 1.82, CI 1.63, 2.03), chest infection (OR 2.70, CI 1.21, 6.70), and urinary tract infection (OR 1.60, CI 1.11, 2.31), but less obstetric intervention. Operative vaginal delivery (OR 0. 46, CI 0.41, 0.56), elective cesarean (OR 0.47, CI 0.35, 0.65), or emergency cesarean (OR 0.45, CI 0.38, 0.53) were all less likely in women aged less than 18 years. Women less than 18 years old were no more likely to have stillbirths (OR 0.75, CI 0.42, 1.34) or small-for-gestational-age infants (OR 0.95, CI 0.82, 1.09) than women aged 18-34 years. CONCLUSION: Pregnant women less than 18 years old were more likely to deliver preterm than older women. In most other respects they have less maternal and perinatal morbidity and were more likely to have normal vaginal deliveries.     

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.     

Incidence and birth weight characteristics of twins born to mothers aged 40 years or more compared with 35-39 years old mothers: a population study

OBJECTIVE: To compare the incidence of twin births and their birth weight characteristics in mothers aged > or = 40 years with those of mothers aged 35-39 years. METHODS: We used a population-based cohort of Israeli twins delivered between 1993-98 to compare birth weight characteristics of 510 and 2102 twin pairs delivered to mothers aged > or = 40 years (cases) and 35-39 years (controls), respectively. RESULTS: The incidence of twin mothers aged 40 years or more increased 50% during the study period, ten times more than mothers aged 35-39. There were significantly more nulliparas (P < .001, OR 1.54, 95% CI 1.2, 1.9) and more para > or = 4 (P < .004, OR 1.38, 95% CI 1.1, 1.7) among older mothers. Irrespective of parity, there were no significant differences between mean twin birth weight, total twin birth weight < 3000 g, 3000-4999 g, and > or = 5000 g, and frequencies of very low birth weight neonates. CONCLUSIONS: Twin birth at the age of > or = 40 years is significantly more likely among either nulliparas or para > or = 4. Birth weight characteristics of twins delivered to mothers aged > or = 40 years are not different from those delivered to 35-39 years old mothers.     

Cerclage for short cervix on ultrasonography: meta-analysis of trials using individual patient-level data

OBJECTIVE: Preterm birth is the main cause of perinatal morbidity and mortality. A short cervical length on transvaginal ultrasonography predicts preterm birth. Our aim was to estimate by meta-analysis of randomized trials whether cerclage prevents preterm birth in women with a short cervical length. DATA SOURCES: MEDLINE, PubMed, EMBASE, and the Cochrane Library were searched with the terms "cerclage," "cervical cerclage," "short cervix," "ultrasound," and "randomized trial." We included randomized trials involving the use of cerclage in women with short cervical length on transvaginal ultrasonography using patient-level data. TABULATION, INTEGRATION, AND RESULTS: Four properly conducted trials were identified. In the total population, preterm birth at less than 35 weeks of gestation occurred in 29.2% (89/305) of the cerclage group, compared with 34.8% (105/302) of the no-cerclage groups (relative risk [RR] 0.84, 95% confidence interval [CI] 0.67-1.06). There was no significant heterogeneity in the overall analysis (P = .29). There was a significant reduction in preterm birth at less than 35 weeks in the cerclage group compared with the no-cerclage groups in singleton gestations (RR 0.74, 95% CI 0.57-0.96), singleton gestations with prior preterm birth (RR 0.61, 95% CI 0.40-0.92), and singleton gestations with prior second-trimester loss (RR 0.57, 95% CI 0.33-0.99). There was a significant increase in preterm birth at less than 35 weeks in twin gestations (RR 2.15, 95% CI 1.15-4.01). CONCLUSION: Cerclage does not prevent preterm birth in all women with short cervical length on transvaginal ultrasonography. In the subgroup analysis of singleton gestations with short cervical length, especially those with a prior preterm birth, cerclage may reduce preterm birth, and a well-powered trial should be carried out in this group of patients. In contrast, in twins, cerclage was associated with a significantly higher incidence of preterm birth.     

Antenatal transfer of rural women to perinatal centres. High Risk Obstetric and Perinatal Advisory Working Group

The aim of this study was to describe antenatal transfers of rural women to perinatal centres, and among transferred women, to assess the use of selected evidence-based therapies and determine the predictors of preterm and imminent births. The clinical records of rural women antenatally transferred to perinatal centres in NSW and the ACT during 1997-1998 were reviewed. Of 453 rural antenatal transfers, 408 (90%) were emergency transfers. Increasing remoteness was associated with increased rates of antenatal transfer but not with a lower probability of giving birth. Of all transferred women, 64% delivered; 58% of preterm transfers delivered preterm and of those delivering preterm, 76% delivered within 7 days. Although the main reason for antenatal transfer was the possibility of preterm birth, women presenting with preterm contractions only were less likely to deliver preterm (OR = 0.2, 95% CI 0.1-0.4) or < or = 7 days (OR = 0.3, 95% CI 0.2-0.5) than women with any other presenting symptoms. The overall usage of effective interventions (antenatal steroids, antibiotics for PPROM and beta-mimetic tocolysis to delay birth) among antenatally transferred rural women was high, but there is room for increased uptake prior to transfer.     

Effects of a single course of corticosteroids given more than 7 days before birth: a systematic review

OBJECTIVES: To determine the risk of fetal, neonatal and maternal mortality and morbidity for women and their infants who remained undelivered more than 7 days following a course of prenatal corticosteroids. DESIGN: Systematic review. POPULATION: Women who gave birth more than 7 days after a course of prenatal corticosteroids compared with women not administered corticosteroids. METHODS: Seven randomised controlled trials were identified which reported outcomes for women and their babies who remained undelivered more than 7 days after exposure to a single course of corticosteroids compared with a placebo/no treatment group. MAIN OUTCOME MEASURES: Fetal, neonatal and maternal mortality and morbidity. RESULTS: Seven trials involving 862 infants, 434 born to corticosteroid treated women and 428 to control women were included in this review. For corticosteroid treated infants there was no reduction in the risk of respiratory distress syndrome (relative risk (RR), 0.72; 95% confidence interval (CI), 0.49-1.07), or stillbirth (RR, 1.67; 95% CI, 0.86-3.25). However, there was a tripling in risk of death for liveborn corticosteroid treated infants (RR, 3.24; 95% CI, 1.32-7.96; P = 0.01), and a doubling in risk of perinatal mortality (RR, 2.13; 95% CI, 1.27-3.57; P < 0.01). Corticosteroid treated infants were born on average 5 days earlier than controls (95% CI, -9.15 to -0.85 days, P = 0.02). Their mothers were more likely to have chorioamnionitis (RR, 2.91; 95% CI, 1.25-6.74; P = 0.01). CONCLUSIONS: Infants exposed to corticosteroids more than 7 days before birth had no reduction in risk of respiratory distress syndrome but increased perinatal mortality.     

Impacto de la edad materna avanzada en las complicaciones obstétricas y perinatales de las gestaciones gemelares

Objective

To evaluate the pregnancy and perinatal outcomes of twin gestations in women aged 35 or older.

Material and methods

We designed a retrospective cohort study. Maternal complications, mode of delivery and perinatal outcomes were compared in 229 women who delivered at age 35 or older and in 374 women who delivered at age less than 35 years. The computerized database and medical records of pregnant women attending the Miguel Servet University Hospital from January 2001 to December 2007 were retrospectively reviewed.

Results

Older women had an increased risk of conceptions after assisted reproductive techniques (p > 0.001), dichorionic pregnancies (p > 0.001) and gestational diabetes (p = 0.007; 95% CI: 1.119-3.19). There was no significant association between older maternal age and an increased incidence of preterm labor, premature rupture of membranes, fetal growth restriction, cesarean delivery or perinatal mortality.

Conclusion

Based on our data and previous studies, advanced maternal age in twin pregnancies does not seem to significantly increase obstetric complications or adverse perinatal results.     

Is grandmultiparity an independent risk factor for adverse perinatal outcomes?

OBJECTIVE: To compare maternal and neonatal outcomes among grandmultiparous women to those of multiparous women 30 years or older. METHODS: A database of the vast majority of maternal and newborn hospital discharge records linked to birth/death certificates was queried to obtain information on all multiparous women with a singleton delivery in the state of California from January 1, 1997 through December 31, 1998. Maternal and neonatal pregnancy outcomes of grandmultiparous women were compared to multiparous women who were 30 years or older at the time of their last birth. RESULTS: The study population included 25,512 grandmultiparous and 265,060 multiparous women 30 years or older as controls. Grandmultiparous women were predominantly Hispanic (56%). After controlling for potential confounding factors, grandmultiparous women were at significantly higher risk for abruptio placentae (odds ratio OR: 1.3; 95% confidence intervals CI: 1.2-1.5), preterm delivery (OR: 1.3; 95% CI: 1.2-1.4), fetal macrosomia (OR: 1.5; 95% CI: 1.4-1.6), neonatal death (OR: 1.5; 95% CI: 1.3-1.8), postpartum hemorrhage (OR: 1.2; 95% CI: 1.1-1.3) and blood transfusion (OR: 1.5; 95% CI: 1.3-1.8). CONCLUSION: Grandmultiparous women had increased maternal and neonatal morbidity, and neonatal mortality even after controlling for confounders, suggesting a need for closer observation than regular multiparous patients during labor and delivery.     

The outcome of blunt abdominal trauma preceding birth

OBJECTIVE: The purpose of this study was to examine the outcome of pregnancies in women suffering blunt abdominal trauma, which preceded birth. METHODS: A retrospective cohort study was performed comparing patients who did and did not suffer blunt abdominal trauma preceding birth. Deliveries occurred during the years 1988-2002 in a tertiary medical center. Data regarding abdominal trauma that led to birth was available from the perinatal database of the center. Stratified analysis, using a multiple logistic regression model, was performed to control for confounders. RESULTS: Fifty-four cases of blunt abdominal trauma leading to birth were identified out of 159,223 deliveries that occurred during the study period. Using a multivariate analysis, with backward elimination, placental abruption (OR = 10.0; 95% CI 3.9-25.5; P < 0.001) and preterm delivery (OR = 2.5; 95% CI 1.3-5.0; P = 0.008) were found to be significantly associated with blunt abdominal trauma. A higher rate of Cesarean deliveries was noted among women suffering abdominal trauma (24.1% vs. 12.2%, P = 0.019). No significant differences were found regarding the perinatal outcome between women who did and did not suffer abdominal trauma, as demonstrated by an Apgar score of less than seven at one (7.4% vs. 4.5%, P = 0.30) and five minutes (1.9% vs. 0.6%, P = 0.28) and by perinatal mortality rates (3.7% vs. 1.5%, P = 0.19). CONCLUSION: Blunt abdominal trauma was significantly associated with placental abruption and preterm delivery. However, the perinatal outcome of these pregnancies was not significantly different from that of the general population.     

Has improved health care provision impacted on the obstetric outcome in teenage women?

Objective: To determine the obstetric outcome in teenage women managed in the recent decade with easily accessible health care provision. Methods: In a retrospective cohort study, maternal demographics, underlying medical conditions, obstetric complications, preterm birth, type of labor, mode of delivery, and perinatal mortality were compared between 1505 women aged ≤19 years (study group) with 10,320 women aged 20–24 years (comparison group), who were carrying singleton pregnancies beyond 24 weeks of gestation and managed in our hospital between January 1998 and June 2008. Results: The study and comparison groups accounted for 2.2% and 15.1% respectively of the total deliveries. Despite comparable health status and rates of other obstetric complications, teenage women was associated with birth <34 weeks (aOR 2.45, 95% CI 1.67–3.60), birth at 34–36 weeks (aOR 2.13, 95% CI 1.71–2.65), and reduced instrumental vaginal (aOR 0.62, 95% CI 0.50–0.77) and caesarean (aOR 0.79, 95% CI 0.64–0.97) delivery, without increase in perinatal mortality. Conclusions: Teenage women had increased preterm birth, despite improved health care provision, nutrition, and similar incidence of other obstetric complications, but the obstetric and perinatal outcome remained favorable.     

Placental inflammation and perinatal outcome

OBJECTIVE: To examine the role of placental inflammation in adverse obstetrical outcome (AOO). METHODS: Analysis of perinatal data of 701 randomly selected mothers of singleton infants, Mombasa, Kenya. RESULTS: There were 661 (94.3%) live infants and 40 (5.7%) stillbirths. Out of the live born infants, 78 (12.4%) had a low birth weight (LBW < 2500g); 33 of them were preterm and 41 small for gestational age (SGA). The incidence of neonatal sepsis and post partum endometritis was 3.6 and 19.8%, respectively. The perinatal death rate was estimated to be 7.3% (51/701). The prevalence of acute placental inflammation was 19.6%. Acute placental inflammation was independently associated with preterm low birth weight (ARR=3.8, 95% CI=1.7-8.9, P<0.01), stillbirth (ARR=2.3, 95% CI=1.1-5.0, P=0.03) and perinatal death (ARR=2.8, 95% CI=1.4-5.4, P<0.01). Women with acute placental inflammation had a two-fold higher risk for AOO (32.6 versus 15.2%, respectively, ARR=2.5, 95% CI=1.3-4.8, P<0.01). Other risk factors for AOO were bad obstetrical history, low haemoglobin level and leucocytosis. CONCLUSIONS: The incidence of adverse obstetrical outcome defined as low birth weight, low Apgar score, perinatal mortality and post partum endometritis, was high in this population. Acute placental inflammation was associated with preterm birth, stillbirth and perinatal death. More research is needed to study the role of infection in adverse obstetrical outcome, and to design interventions to decrease infectious morbidity and mortality in pregnancy.     

The epidemiologic incidence of congenital gastroschisis in Western Australia

OBJECTIVE: The purpose of this study was to review the population incidence of congenital gastroschisis in Western Australia over the past 2 decades. STUDY DESIGN: A population-based incidence study of congenital gastroschisis from 1980 to 2001. Maternal and perinatal outcome data were collected to ascertain incidence, treatment, and outcome trends. RESULTS: One hundred twenty-two cases of gastroschisis were identified. The median maternal age was 23 years (range, 16-35 years). Women aged <20 years were at a 7.82 increased risk (95% CI, 4.34-14.08); women aged 20 to 24 years were at a 3.24 increased risk (95% CI, 1.88-5.61) for fetal gastroschisis compared with women aged >or=25 years. An incidence analysis over time indicated a significant increase of gastroschisis cases from 1 of 10,000 births during the period 1980-1990 to the current rate of 2.4 of 10,000 births (P<.001). The perinatal mortality rate was 12.7% (95% CI, 8.7-16.7) with a 9.8% stillbirth rate (95% CI, 6.3-13.3). CONCLUSION: There has been a sustained increase in the birth incidence of gastroschisis over the past decade, particularly in teenage women. A significant fetal death rate in the third trimester is observed.     

Maternal age and risk of fetal death in singleton gestations: USA, 1995-2000.

OBJECTIVE: To determine the magnitude of risk for fetal death among singleton pregnancies in relation to maternal age, and to compare the risks with other common indications for fetal testing. STUDY DESIGN: We performed a retrospective cohort analysis of singleton births delivered between 1995 and 2000 using the US linked birth/infant death data. Gestational age at < 24 weeks and fetuses with anomalies were excluded. Fetal death rates at > or = 24 and > or = 32 weeks were calculated among women aged 15-19, 20-24, 25-29, 30-34, 35-39, 40-44 and 45-49 years, as well as for other common indications for testing: chronic and pregnancy-induced hypertension, diabetes and small-for-gestational age (SGA). The association between maternal age and fetal deaths was derived after adjusting for potential confounders through multivariable logistic regression models. Relative risks (RR) and 95% confidence intervals (CI) were derived from these models after adjusting for the effects of gravidity, race, marital status, prenatal care, education, smoking and placental abruption. RESULTS: Among the 21,610,873 singleton births delivered at > or = 24 weeks, fetal deaths occurred in 58,580 (2.7 per 1000). Births to young (15-19 years) and older (> or = 35 years) women comprised 12.6% and 11.4%, respectively. Compared with women aged 20-24 years, young women did not experience an increased risk of fetal death. However, increasing rates of fetal death at > or = 24 and at > or = 32 weeks were seen with increasing maternal age. The RR for fetal death at > or = 24 and at > or = 32 weeks among women 35-39 years were 1.21 and 1.31, respectively, while the RRs were 1.62 and 1.67 among women aged 40-44 years. Women 45-49 years were 2.40-fold (95% CI 1.77, 3.27) and 2.38-fold (95% CI 1.64, 3.46) as likely to deliver a stillborn fetus at > or = 24 weeks and > or = 32 weeks, respectively. RRs for fetal death at > or = 24 and > or = 32 weeks for hypertensive disease, diabetes, and SGA ranged between 1.46 and 4.95. CONCLUSION: Fetal deaths are increased among older women (> or = 35 years). Fetal testing in women of advanced maternal age may be beneficial.     

Estonian medical birth registry 1992–1994: Association of risk factors with perinatal mortality

Objective: To investigate the association of different maternal sociodemographic characteristics and infant sex with perinatal mortality among primiparas and multiparas. Study design: Analysis of routine data from the Estonian Medical Birth Registry covering the whole of Estonia. A total of 47 358 infants (including stillborns) with a birth weight 1000 g or more from 1992 through 1994 were studied. Perinatal mortality rate, crude odds ratio (OR) and adjusted OR (calculated by a logistic regression model) were used to evaluate the association. OR values were adjusted for maternal age at delivery, maternal ethnicity, educational level, residence, marital status, smoking status, history of previous abortion and infant sex. Results: The perinatal mortality rate was 12.2 per 1000 total births among primiparous and 14.3 among multiparous women. The highest adjusted ORs of perinatal deaths were found in older (35 years and over) primiparas (1.78; 95% confidence interval (CI 0.88-3.57)) and multiparas (1.81; 95% CI 1.29-2.55), in unmarried (single) primiparas (1.59; 95% CI 1.14-2.20) and multiparas (1.98; 95% CI 1.29-3.05), in smoking primiparas (1.69; 95% CI 1.09-2.63) and multiparas (1.51; 95% CI 1.02-2.25), and in multiparas with unknown smoking status (1.98; 95% CI 1.18-3.33). Conclusion: The study provides further evidence that perinatal mortality is positively associated with increased maternal age, unmarried (single) status and smoking.