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  • Title: Impact of advanced maternal age on the outcome of pregnancy.
    Author: Ales KL, Druzin ML, Santini DL.
    Journal: Surg Gynecol Obstet; 1990 Sep; 171(3):209-16. PubMed ID: 2385814.
    Abstract:
    We assessed the impact of advanced maternal age on the outcome of pregnancy by studying all 1,328 women who were primarily cared for and delivered at our institution between 14 September 1984 and 12 February 1985. Important peripartum maternal complications were no more frequent in women aged 35 years or more than in women 20 to 34 years old, although operative delivery was significantly more common. Similarly, adverse outcomes of infants were no more frequent. Perinatal mortality tended to be lower. In addition, we noted a trend for fewer infants with congenital anomalies to be born among older women. This trend was related, in part, to the choice to terminate the pregnancy by women with fetuses that had documented chromosomal anomalies. We conclude that advanced maternal age was not associated with an excess of adverse pregnancy outcome and suggest that, with early registration and careful surveillance during pregnancy, women aged 35 years or more can experience excellent pregnancy outcomes. The obstetric outcome of 1328 deliveries in a tertiary level hospital was examined, focusing on the results of the women over 35. The study group were all pregnant women over 20 primarily cared for and delivered at the New York Hospital-Cornell Medical Center from September 1984- February 1985, excluding those transferred from other institutions for complications. Among the older women, there was a higher incidence of previous abdominal operations, cesarean sections, previous perinatal death, infertility and alcohol abuse, but relatively few had comorbid conditions or obesity. Most were of higher socioeconomic status and had private physicians. The older group tended to begin prenatal care early, and elect to have amniocentesis. They had a higher risk of gestational glucose intolerance, hypertension and hospitalization during this pregnancy. 45% had cesarean delivery, and their hospital stays were longer. Their rates of vertex presentation, prematurity, postmaturity, macrosomia, induced or augmented labor were similar to those of younger women. There were no maternal deaths. The older group had 1 multiple birth, fewer than the younger women. Perinatal mortality was lowest in the older women. There was 1 intrauterine death and 1 congenital anomaly, lower rates than seen in younger women. This series demonstrates that women over 35 are not at greater risk of adverse pregnancy outcomes if they are cared for early and carefully.
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