VERY ADVANCED MATERNAL AGE - PREGNANCY AFTER AGE 45

OBJECTIVE: Our purpose was to describe the maternal and fetal outcomes of pregnancies in women greater than or equal to 45 years old at deli very. STUDY DESIGN: A retrospective review of in-hospital deliveries a fter 20 weeks of gestation was performed in four Utah tertiary care ho spitals for the 10-year period between 1985 and 1994. RESULTS: Seventy -nine cases were identified among 126,500 births, with an incidence of 0.63 per 1000 births. Maternal ages were 45 (n = 44), 46 (n = 21), an d greater than or equal to 47 (n = 14) years. Three of the conceptions were assisted, including both twin gestations. Thirty-seven (46.8%) h ad obstetric complications during pregnancy; the most frequent complic ations were gestational: diabetes (12.7%) and preeclampsia (10.1%). Me dian (range) gestational age at delivery was 39 (22.9 to 41.7) weeks; 12 (15.2%) deliveries occurred before 37 weeks. Eight (9.9%) karyotype abnormalities were diagnosed. The cesarean section rate was 31.7%; th e most frequent indications were abnormal lie (n = 9), fetal distress (n = 5), and previous cesarean delivery (n = 5). There were no materna l deaths. Median (range) birth weight was 3466 (397 to 5085) gm; 14 (1 7.3%) were <2500 gm and 16 (19.8%) were >4000 gm. Twelve (14.8%) infan ts were admitted to the neonatal intensive care unit. The corrected pe rinatal mortality rate was 1.3%, (1/78). CONCLUSIONS: In women >45 yea rs old at delivery maternal and fetal outcomes were generally good, bu t there was a high incidence of pregestational (chronic hypertension, hypothyroidism) and gestational (karyotype abnormalities, gestational diabetes, cesarean section, macrosomia) complications. This informatio n may be helpful for counseling women between 45 and 50 years old who are considering pregnancy.