EFFECT OF VERY ADVANCED MATERNAL AGE ON PREGNANCY OUTCOME AND RATE OFCESAREAN DELIVERY

Objective: To determine outcomes of pregnancies in women at least 44 y ears of age and to determine factors predicting cesarean delivery in t hese patients. Methods: Between January 1988 and December 1995, 109 wo men at least 44 years old delivered in our medical center. These women were matched to a group of 309 women 20-29 years of age. Multiple log istic regression analysis was used to evaluate the association between maternal age and outcome variables, controlling for possible confound ing factors. Based on the logistic regression, a predictive model was calculated for cesarean delivery and validated prospectively in a sepa rate group of 30 consecutive women at least 44 years old, who delivere d during the first 8 months of 1996. Results: Very advanced maternal a ge, compared with younger age, was associated with a significantly hig her rate of medical complications (hypertensive disorder and diabetes) (odds ratio [OR] 2.5; 95% confidence interval [CI] 1.5, 4.1; P < .001 ), instrument-assisted vaginal delivery (OR 7.5; 95% CI 2.2, 25.0; P < .004), and cesarean delivery (OR 7.3; 95% CI 2.2, 16.7; P < .001). Th e incidences of preterm labor, premature rupture of membranes, emergen cy cesarean delivery, meconium-stained amniotic fluid, small for gesta tional age newborns, and 5-minute Apgar scores of 7 or lower were not influenced by maternal age. The regression model showed an increased r isk for cesarean delivery associated with age of at least 44 years (OR 7.3; 95% CI 2.2, 16.7), primiparity (OR 3.5; 95% CI 1.3, 9.8), infert ility treatment (OR 3.6; 95% CI 1.5, 8.8), and egg donation (OR 19.5; 95% CI 6.1, 62.2), with positive acid negative predictive values of 94 and 86%, respectively. Conclusion: Maternal age of at least 44 years is associated with medical complications in pregnancy and more interve ntions during labor. However, overall pregnancy outcomes are favorable . Cesarean delivery can be predicted accurately based on maternal age, parity, and infertility treatment. (Obstet Gynecol 1998;92:935-9. (C) 1998 by The American College of Obstetricians and Gynecologists.).