Department of Maternal-Fetal and Neonatal Medicine, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo 157-8535, Japan.
Arch Gynecol Obstet. 2012 Apr;285(4):937-41. doi: 10.1007/s00404-011-2099-z. Epub 2011 Oct 5.
To investigate perinatal outcomes in late primiparous women aged 35-39 and ≥40 years. Our main research question: "Was the rate of cesarean section similar between these 2 groups of advanced maternal age?"
Primiparous women aged ≥35 years, who delivered in our center between April 2004 and March 2007, were enrolled in this study. They were divided into two groups: women aged 35-39 years and those aged ≥40 years. Antenatal complications, deliveries, and neonatal outcomes were analyzed. Fetal abnormalities, abortions, and multiple gestations were excluded.
We assessed 752 cases (35-39 years, 610 cases; ≥40 years, 142 cases). Incidence of cesarean section (CS) was significantly higher in pregnant women aged ≥40 years (P < 0.01). The CS rate amounted to 50.0% of all deliveries in this age group. Among patients with labor deliveries, the CS rate was also significantly higher in the older age group (P < 0.05). With regard to indication for CS with labor deliveries, the rate of non-progressive labor/dystocia was 19.4% in primiparous women aged ≥40 years and 11.0% in those aged 35-39 years, respectively (P < 0.05). In contrast, the rates of antenatal complications were not different between the two groups, except for gestational diabetes or leiomyoma. No significant differences between the two groups could be found for neonatal outcomes such as birth weight, Apgar score, and admission to neonatal intensive care unit.
CS rate was 50.0% in primiparous women aged ≥40 years. In addition, CS caused by dystocia was almost twice as frequent in primiparous women aged ≥40 years as in women aged 35-39 years. Among late pregnancies, primiparous women aged 40 years and older had higher risk of CS.
探讨 35-39 岁和≥40 岁高龄初产妇的围产结局。我们的主要研究问题是：“这两组高龄产妇的剖宫产率是否相似？”
本研究纳入 2004 年 4 月至 2007 年 3 月在我院分娩的≥35 岁的初产妇。将她们分为两组：35-39 岁组和≥40 岁组。分析了产前并发症、分娩方式和新生儿结局。排除了胎儿畸形、流产和多胎妊娠。
共评估了 752 例病例（35-39 岁 610 例，≥40 岁 142 例）。≥40 岁孕妇剖宫产率显著高于 35-39 岁孕妇（P<0.01）。该年龄组剖宫产率达所有分娩的 50.0%。在有产程的患者中，高龄组的剖宫产率也显著升高（P<0.05）。对于有产程的剖宫产指征，≥40 岁初产妇因产程进展不良/滞产而行剖宫产的比例为 19.4%，而 35-39 岁初产妇的比例为 11.0%（P<0.05）。然而，两组的产前并发症发生率除了妊娠期糖尿病或子宫肌瘤外并无差异。两组新生儿结局如出生体重、阿普加评分和新生儿重症监护病房入住率无显著差异。
≥40 岁初产妇的剖宫产率为 50.0%。此外，≥40 岁初产妇因产程不良而行剖宫产的比例几乎是 35-39 岁初产妇的两倍。在晚期妊娠中，40 岁及以上的初产妇行剖宫产的风险更高。
