Analysis of pregnancy and delivery ways in nulliparous women over 30 years old

Courses of pregnancy and ways of delivery of 274 nulliparous women aged over 30, who delivered between 1992 and 1998 were analyzed. Control group consisted of 274 nulliparous women aged 22-27, who delivered in the same period. Among the women delivering over 30, premature labours, medical disorders during pregnancy and deliveries by cesarean sections were noticeable more frequent.     

Morbidity of incontinence surgery in women over 70 years old: a retrospective cohort study

OBJECTIVE: To compare the success rate and complications after colposuspension and tension-free vaginal tape (TVT) insertion in women aged 70 years or more compared with younger women. DESIGN: A retrospective study of patients having surgery between November 2000 and October 2002. SETTING: A tertiary referral, academic urogynaecology unit in a University teaching hospital. POPULATION: Two hundred and twenty-six women having surgical treatment for urinary incontinence. METHODS: Data on cure/improvement and complications were extracted from the notes. Patients were grouped by age at surgery and the odds ratios (OR) and 95% confidence intervals (CI) for each outcome were calculated. MAIN OUTCOME MEASURES: Subjective cure rate and the incidence of complications by age group. RESULTS: One hundred and three patients had colposuspension, 11 (10.7%) aged 70 or more. One hundred and twenty-three patients had TVT insertions, 23 (18.7%) aged 70 or more. The cure rate for each procedure was similar between age groups. After colposuspension, urinary tract infection (UTI; OR 11.33; 95% CI 2.61, 49.28) and long term self-catheterisation (percentage of difference 9.1; 95% CI 3.0, 15.2) were more common in women over 70. After TVT, repeat urodynamics (OR 3.91; 95% CI 1.11, 13.76), recurrent UTI (OR 4.22; 95% CI 1.03, 17.26) and tape division (OR 29.12; 95% CI 3.20, 264.86) were more common in older women. CONCLUSIONS: Incontinence surgery carries a higher risk of complications in the elderly including UTI and voiding dysfunction. Extended antibiotic prophylaxis and intermittent self-catheterisation training should be offered to elderly women before surgery.     

Endometrial cancer in women 40 years old or younger

OBJECTIVE: The aim of this study was to characterize endometrial cancer in women 40 years of age and younger, with special attention toward body-mass index (BMI). METHODS: A retrospective review of women age 40 and under with endometrial cancer was performed. Patients were identified via tumor registry data as well as a search of pathology department diagnoses over the dates 1980-1998. Data were abstracted regarding tumor grade and histology, stage, treatment, smoking, use of oral contraceptives, BMI, medical and family history, parity, and survival. Data were also collected with regard to uterine conservation and pregnancies following endometrial cancer diagnoses. RESULTS: Ninety-five patients were identified. The age range was 24-40 years (median 37) with BMI ranging from 17.5 to 63.6 (median 28.4). Forty-eight patients (52%) were not obese, with BMI < 30. Seventy-six patients (80%) had stage I disease and 60 patients (63%) had grade 1 disease. All but 4 patients had endometrioid histology. Women with BMI < 25 were more likely to have advanced disease (P = 0.04) and more likely to have high-risk histology (P = 0.02). Of the 4 patients with high-risk histology (clear cell or serous papillary), all had BMI < 25. Twelve patients were treated medically rather than surgically, and 4 patients achieved pregnancy, with 5 live births. CONCLUSION: Women under 40 who are not obese are at higher risk of both advanced disease and high-risk histology. Further study at the molecular and genetic level is ongoing in our laboratory to determine whether the mechanism of disease is different in slender woman.     

Uterine fibroids affect pregnancy outcome in women over 30 years old: role of other risk factors

Objective: To evaluate the pregnancy outcome in women >30 years old with uterine fibroids also considering other possible concomitant risk factors. Methods: A multicentric, observational and retrospective study was conducted. All women were asked to complete a questionnaire while they were in hospital and the outcome of pregnancy was investigated. Results: Women with uterine fibroids before pregnancy were more frequently >35 years old and in their clinical history before pregnancy showed more pelvic pain, polliachiuria, previous pelvic surgery, hypermenorrhea and dysmenorrhea, than control women (p < 0.0001). During pregnancy patients with uterine fibroids showed significantly more threatened preterm birth (PTB) and PTB, weight gain, hyperemesis, gestational hypertension and post-partum bleeding and showed more often requirement for emergency cesarean section (p < 0.0001). The multivariate logistic regression model used for evaluating the effect of clinical parameters on outcome of pregnancy showed that age >35 years, pelvic pain, work, weight gain, hyperemesis, threatened miscarriage and threatened PTB were significantly correlated with unfavorable pregnancy outcome , independently of the presence of uterine fibroids (p < 0.0001). Conclusions: The present study confirming a more frequent negative pregnancy outcome in presence of uterine fibroids, showed that other risk factors may affect pregnancy and delivery outcome in women aging >30 years old.     

Assisted reproductive techniques in women aged 38 years or more

OBJECTIVE: More and more young women are delaying childbearing until the fourth decade of life: thus, Assisted Reproductive Techniques centres receive more and more requests from ageing women. The aim of the study is to analyse the purpose of these requests, the biological and clinical features of these patients and the results in our infertility centre. PATIENTS AND METHODS: A retrospective study was carried out at the CHU of Saint-Etienne from 01.01.01 to 31.12.04. We analysed the social, clinical and biological features of 84 couples when the woman's age was equal or superior to 38 years, representing 218 cycles. A questionnaire was used to collect social data. RESULTS: Several factors can explain the increasing number of ageing women consulting for infertility: extend university time and professional career, professional stability, contraception and late meeting of the partner, false reassuring information concerning progress in ART, second child desire after a late first pregnancy, but also second marital unions and child desire in the redefined couple. In our study, above 40 years old, the pregnancy (19.4 versus 10.5%) and delivery rates (16.7 versus 5.8%) clearly decreased in IUI. Thus, most of the clinicians propose, in first choice, an IVF cycle to a 40 year-old woman. The ultrasound measurement of antral follicle count can accurately evaluate the prognosis in terms of pregnancy (P<0.01) and delivery rate (P=0.03). For patients with unfavourable prognosis, oocyte donation, embryo donation, or adoption can be considered. DISCUSSION AND CONCLUSION: ART cannot compensate for the natural decrease in pregnancy rates and the increase in early miscarriages in ageing women. Therefore, it is essential to inform young women of the negative effects of age on their potential fertility.     

Cost-effectiveness of IVF in women 38 years and older.

OBJECTIVE: To compare the cost per delivery in women younger than 38 years with women equal to or older than 38 years of age attempting IVF. METHODS: All couples undergoing IVF treatment between October 1991 and September 1998 were enrolled in this study. A standard protocol of controlled ovarian hyperstimulation was employed throughout the study. Four hundred and seven cases were allocated to two groups - group I composed of patients younger than 38 years of age and group II of patient equal to or older than 38 years of age. The total cost of each successful outcome was the goal of our study. RESULTS: A total of 407 women underwent 722 stimulated cycles for IVF of which 122 cycles (16.89%) did not proceed to oocyte retrieval. We found statistically significant differences in the cancellation rate, the number of hMG ampoules, the number of oocytes retrieved, the number of oocytes fertilized, the number of embryos transferred, the clinical pregnancy rate, the rate of multiple pregnancy, the delivery per initiated cycle and the cost per delivery between the two groups (P<0.05, significant). The cost per delivery in group II was approximately 3.6 times that of group I. CONCLUSIONS: Women age 38 years or more have less chance of a successful outcome from IVF treatment. Couples contemplating IVF should be provided with accurate information about prognosis for the pregnancy and the financial costs.     

Increased human menopausal gonadotropin dose during the early follicular phase: Effect on follicular recruitment and treatment outcome

Summary To investigate whether the provision of increased gonadotropins would enhance follicular recruitment and selection, women not responding (N=18) to our standard clomiphene citrate (CC)-human menopausal gonadotropin (hMG) regimen were treated with increased hMG (treatment cycle II). Estradiol levels were higher in treatment cycle II and these differences were significant on days 8 and 9 (P0.05 andP0.03, respectively). On day 9, better follicular development was seen in cycle II (P0.05). While none of the patients responded in cycle I, 10 of 18 responded in cycle II. Of the 10 responders, 2 conceived following in vitro fertilization and embryo placement. Increasing the dose of hMG improved the development of a cohort of follicles so that aspiration and possible pregnancy were achieved in women who were previously unresponsive to therapy.     

Exercise for women in the early postmenopausal years

Exercise has many benefits throughout life but in later life in particular it will protect against cardiovascular disease, obesity, diabetes and cancer, and preserve musculoskeletal health and psychological wellbeing. Women as they get older are at increasing risk of osteoporosis and the aim of exercise is to slow these skeletal changes. The early postmenopausal years in particular are associated with a rapid loss of bone mass, together with a loss of aerobic fitness and muscle strength. Therefore an evidence-based exercise regime to protect against these problems is essential, so that the exercise is of the appropriate quantity, duration and intensity for the required outcome.     

Induction of labour at term for women over 35 years old: a survey of the views of women and obstetricians

Objectives

To determine the views of UK women and obstetricians relating to induction of labour at term for women over 35 years of age.

Study design

Cross-sectional web-based survey sent to members of the British Maternal and Fetal Medicine Society (BMFMS) and pregnant or recently delivered members of a large social network site for parents (www.mumsnet.com). One hundred and twenty-eight consultant obstetrician members of BMFMS and 663 pregnant or recently delivered women responded.

Results

Two hundred and eighty-eight women (43%) would consider induction of labour for maternal age alone, and 192 women (29%) would consider participating in a randomised trial of induction of labour at term versus expectant management in a future pregnancy. Three percent (n = 4) of consultant obstetricians offer induction of labour at term to women at 35–39 years of age, 37% (n = 47) to women at 40–44 years of age and 55% (n = 70) to those over 45 years. Sixty-one consultants (48%) would participate in a trial to test the effect of a policy of induction for nulliparous women over 35 years old.

Conclusions

The policy of offering induction of labour at term for advanced maternal age is widespread and a significant percentage of women consider it to be a valid indication.     

Revisiting the role of LH in follicular development

During the last decade, two pivotal events widened the gap between the hormonal dynamics of ovarian stimulation and that of the menstrual cycle. First, the profound and routine suppression of endogenous gonadotropins by GnRH analogues used in ovarian stimulation pressed us to recreate the hormonal environment necessary for adequate follicular maturation and steroidogenesis. Second, drugs with reduced or null LH activity became available, based on the hypothesis that FSH action was sufficient to follicular development and maturation irrespective of residual endogenous gonadotropin levels. Today, there is a renewed interest in the possible role of LH on follicular development, in an effort to mimic the hormonal events of the menstrual cycle to optimize ovarian stimulation outcome.     

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.     

Remote prognosis of preeclampsia in women 25 years old and younger

Twenty-six primiparous women less than or equal to 25 years old who delivered between 1963 and 1978 and met the following criteria were studied: (1) The first obstetric visit was at less than or equal to 30 weeks' gestation with diastolic blood pressure less than or equal to 85 mm Hg; (2) diastolic blood pressure before delivery was greater than or equal to 95-mm Hg, rising at least 15 mm Hg; (3) 24-hour urine protein measured at least 1.0 gm; and (4) patients were enrolled in the Kaiser Health Plan in 1982. Each of the 26 patients was paired with a primiparous woman by year delivered, age, race (black versus nonblack), and weight +/- 1/3. In 23 pairs blood pressure follow-up was available in 1980 or thereafter, which was at least 3 1/2 years after delivery (average interval between delivery and follow-up = 10 years). Three in the preeclampsia group and two in the matched control group had hypertension, with diastolic blood pressure greater than or equal to 90 mm Hg. Mean systolic blood pressure (123.7 mm Hg) was 9.3 mm Hg higher in the preeclampsia group than in the matched controls (114.4 mm Hg), with a standard error of 4.15 mm Hg (p = 0.04). Mean diastolic blood pressure (77.0 mm Hg) was 2.9 mm Hg higher in the preeclampsia group than in the controls (74.1 mm Hg), with a standard error of 3.0 mm Hg (p = 0.345). We conclude that no significant difference in frequency of hypertension or diastolic blood pressure and a small but significant difference in systolic blood pressure is shown in follow-up between patients with preeclampsia and matched controls.     

Problems in diagnosing breast cancer in women younger than 25 years old

OBJECTIVES: There are several challenges in the diagnosis of breast cancer in young women. Special consideration must be given to the woman's fertility and body image issues, but the difficulty in distinguishing benign from malignant lesions in this group of patients still exists. The aim of our study was to show five cases of breast cancer in young women. MATERIALS AND METHODS: Based on 5 cases of breast cancer in women younger than 25, several methods used in diagnosis in this group of patients were discussed. The role of USG and BAC was analyzed. Moreover, a significant role of RM and PET was emphasized. RESULTS: Diagnosing and treatment of young patients with breast cancer should be performed in specialized oncological centers experienced in dealing with breast cancer in very young women. CONCLUSIONS: 1. Because of the possibility of breast cancer in women under 25 years old, each case of breast tumor should be precisely diagnosed, especially by ultrasonography and biopsy (BAC) 2. Each case suspected of breast cancer in young women should be diagnosed in highly equipped and specialized medical center.     

Genetic amniocentesis in women 20-34 years old: associated risks

The aim of this retrospective controlled study is to evaluate the impact of predisposing factors on amniocentesis-related fetal loss. It comprises 3910 consecutive cases of women, aged 20-34 years, who had genetic amniocentesis during the years 1992-97 (study group). The control group comprised 5324 women under 35, at low risk for Down syndrome, during the same period. The fetal losses in both groups were analysed, in respect of: (a) maternal historical conditions; and/or (b) bleeding during current pregnancy. The leading indication for amniocentesis in women 20-34 years was maternal anxiety, mainly for marginal age (33-34 years), which accounted for a remarkable 34.4% of the study group. Total fetal loss rate up to the 28th week was 2.1% in the study group versus 1. 5% in controls. A history of previous spontaneous or induced abortions, as well as bleeding during the current pregnancy, was associated with a substantial rise of fetal loss in both groups. In cases with no predisposing factors, the added fetal loss rate was 0.03%. Previous abortions and bleeding during the current pregnancy are associated with the most fetal losses after amniocentesis. In the absence of these, the added fetal loss rate (0.03%) is non-significant.