Do primiparas aged 40 years or older carry an increased obstetric risk?

Background. It is unclear whether older primiparas are at increased risk fo r complications of pregnancy other than an increased cesarean section rate. The aim of this study was to compare the rate of complications of pregnanc y and delivery of primiparas aged 40 years or older with those of primipara s aged 20 to 30 years. Methods. We reviewed the maternal and neonatal hospital records of 59 conse cutive primiparas aged 40 years or older who delivered at our institution; between 1986 and 1995. A total of 118 primiparas aged 20 to 30 years who pr eceded and followed the cases served as controls. Results. The mean duration of gestation was significantly shorter in primip aras greater than or equal to 40 years of age. Induction of labor was more common and the cesarean delivery rate was higher (47 vs 12%) in older primi paras. The mean birth weight was significantly lower in the offspring of th e cases. The perinatal mortality rate was 5% in the primiparas over 40 year s and 0% in the control group; fetal malformations were found in 5% (vs 1%) of the children of older primiparas. Conclusions. In our series, older primiparas were at increased risk for pre maturity, preeclampsia, and perinatal mortality. The high rate of cesarean section in older primiparas is due mainly to a higher incidence of obstetri c complications. These data suggest that the prenatal care of older primipa ras in the third trimester should concentrate on the early detection of pre mature contractions and signs of preeclampsia. (C) 1999 American Health Fou ndation and Academic Press.