Increased risk of cesarean delivery with advancing maternal age: Indications and associated factors in nulliparous women

OBJECTIVE: To investigate factors that contribute to the increased risk of cesarean delivery with advancing maternal age. STUDY DESIGN: We reviewed demographic and ante- and intrapartum variables f rom a data set of term, nulliparous women who delivered at Brigham and Wome n's Hospital in 1998 (n = 3715). RESULTS: Cesarean delivery rates Increased with advancing maternal age (< 2 5 years, 11.6%; greater than or equal to 40 years, 43.1 Older women were mo re likely to have cesarean delivery without labor (< 25 years, 3.6%; greate r than or equal to 40 years, 21.1 Malpresentation and prior myomectomy were the indications for cesarean delivery without labor that were more prevale nt in our older population as compared to our younger population. Even amon g women with spontaneous or induced labor, cesarean delivery rates increase d with maternal age (< 25 years, 8.3%; greater than or equal to 40 years, 3 0.6%). Cesarean delivery rates were higher with induced labor, and rates of induction rose directly and continuously with maternal age, especially the rate of elective induction. Cesarean delivery for failure to progress or f etal distress was more common among older parturients, regardless of whethe r labor was spontaneous or induced. Among women who underwent cesarean deli very because of failure to progress, use of oxytocin and length of labor di d not vary with age. CONCLUSIONS: Older women are at higher risk for cesarean delivery In part b ecause they are more likely to have cesarean delivery without labor. Howeve r, even among those women who labor, older women are more likely to undergo cesarean delivery, regardless of whether labor is spontaneous or induced. Part of the higher rate among older women who labor is explained by a highe r rate of induction, particularly elective induction. Among women In both s pontaneous and induced labor, cesarean delivery for the diagnoses of failur e to progress and fetal distress was more frequent in older patients, altho ugh management of labor dystocia for these patients was similar to that for younger patients.