Pregnancy Outcome in Ladies Aged 40 Years and Above

Author(s): Mahabat S. Saeed, Atiya K. Mohammed, Rowshan J. Azeez

Many women today are delaying childbearing until the fourth decade of life. The reasons for these delays are multiple and include pursuance of professional careers and delaying of marriage. To study the impact of the maternal age on pregnancy outcome in ladies ≥40 years old. This is a prospective observational case control study conducted at Sulaimania Maternity Teaching Hospital. Time of data collection was from 1st of December 2013 to the 1st of June 2014. A total of 300 women were included in the study, 150 cases aged 40 and above as a study group and 150 cases aged 20-29 as a control group, these cases were collected from labour room and operative theatres. All the women included in the study, gave verbal consent and the following informations were obtained by questionnaire forms : Age, parity, gestational age of her pregnancy by LMP and US, any complications during pregnancy like PET, GDM, PIH, PROM, APH, PPH, past medical history, past surgical history and obstetrical history has been also recorded. Duringlabour fetal heart rate monitoring was done with intermittent auscultation by sonic aid only, if meconium detected in the liquor or any fetal HR abnormality then continuous (FHR) monitoring was done until delivery. Mode of delivery by vaginal delivery (normal or operative vaginal delivery) or by caesarean section and its indications were also recorded. Fetal outcome was measured by APGAR scores at 1st& 5th minute, birth weight, admission to neonatal care unit, and during the period of admission observation of development of any neonatal complications including respiratory distress, meconium aspiration syndrome, neonatal death or improvement and discharge were recorded. After discharge from NCU and hospital, follow up of the babies for one month was done by phone calling of the family of the baby and asking about his/her health and if developed any complications or readmitted again to hospital these information also were recorded. A total of 150 cases aged from 20-29 women were enrolled in the study as a control group and 150 cases aged 40 and more were enrolled as a study group. Mean gestational age of the study group was 37.4 + 2.0 weeks and 38.4 + 1.7 weeks in the control group, the difference was statistically highly significant, P<0.01. Gestational diabetes, pre-eclampsia, placenta abruption were significantly higher in the study group (26.0%, 45.3%, 8.7%, respectively) compared to control group (11.3%, 16.0%, 1.3% respectively). Caesarean deliveries were high (61.3%) in the study group and it was much higher with history of previous caesarean (48.9%). Incidence of PPH was higher in the study group (30.7%) compared to (16.0%) in control group. APGAR at fifth minute was approximately similar in both groups and statistically was not significant. Admission to neonatal care unit NCU was (50.7%) in study group compared to (16.0%) in control group. Neonatal mortality was high (1.3%) in study group than control group(0.0%). Study conclude Women aged 40 years and above have increased risk of complications during pregnancy and they have a higher risk of operative delivery. Despite of these complications and increased of maternal morbidity in the older women, the overall neonatal outcome did not appear to be affected.

Pregnancy, maternal age > 40, maternal outcome, fetal outcome

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