Department of Obstetrics, Gynecology, and Reproductive Science, Mount Sinai School of Medicine, USA; Maternal Fetal Medicine Associates, PLLC, Carnegie Imaging for Women, PLLC, USA; Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA.
Eur J Obstet Gynecol Reprod Biol. 2013 Oct;170(2):387-90. doi: 10.1016/j.ejogrb.2013.07.035. Epub 2013 Aug 6.
To estimate the effectiveness of antepartum surveillance and delivery at 41 weeks in reducing the risk of stillbirth in advanced maternal age (AMA) patients.
Retrospective cohort study of all patients managed in one maternal-fetal medicine practice from June 2005 to May 2012. We included all singleton pregnancies delivered at ≥ 20 weeks of gestation. All AMA patients (age ≥ 35 years at their estimated delivery date) underwent weekly biophysical profile testing beginning at 36 weeks, as well as planned delivery at 41 weeks, or sooner if indicated. We compared the rate of fetal death at ≥ 20 weeks and fetal death at ≥ 36 weeks in AMA vs. non-AMA patients. Fetal deaths due to lethal and chromosomal abnormalities were excluded.
4469 patients met the inclusion criteria: 1541 (34.5%) were AMA and 2928 (65.5%) were non-AMA. Using our AMA protocol for surveillance and timing of delivery, the incidence of stillbirth was similar to the non-AMA population (stillbirth ≥ 20 weeks: 3.9 per 1000 vs. 3.4 per 1000, p=0.799; stillbirth ≥ 36 weeks: 1.4 per 1000 vs. 1.1 per 1000, p=0.773). When looking at women age <35, age 35-39, and age ≥ 40, the incidence of stillbirth ≥ 20 weeks and ≥ 36 weeks did not increase across the three groups. Our findings were similar when we excluded all patients with other indications for antepartum surveillance.
In AMA patients, antepartum surveillance and delivery at 41 weeks appears to reduce the risk of stillbirth to that of the non-AMA population. Routine antepartum surveillance should be considered in all AMA patients.
评估在高龄产妇（AMA）中进行产前监测和 41 周分娩以降低死胎风险的效果。
对 2005 年 6 月至 2012 年 5 月期间在一家母胎医学实践中管理的所有患者进行回顾性队列研究。我们纳入了所有在妊娠 20 周以上分娩的单胎妊娠。所有 AMA 患者（在预计分娩日期≥35 岁）在 36 周时开始每周进行生物物理概况检查，并在 41 周或出现指征时进行计划分娩。我们比较了 AMA 与非 AMA 患者在≥20 周和≥36 周时的胎儿死亡发生率。排除了因致命和染色体异常导致的胎儿死亡。
4469 名患者符合纳入标准：1541 名（34.5%）为 AMA，2928 名（65.5%）为非 AMA。使用我们的 AMA 监测和分娩时机方案，死胎发生率与非 AMA 人群相似（≥20 周的死胎：3.9/1000 与 3.4/1000，p=0.799；≥36 周的死胎：1.4/1000 与 1.1/1000，p=0.773）。当观察年龄<35 岁、35-39 岁和≥40 岁的女性时，三组中≥20 周和≥36 周的死胎发生率并未增加。当排除所有具有其他产前监测指征的患者时，我们的发现也相似。
在 AMA 患者中，产前监测和 41 周分娩似乎降低了死胎风险，使其与非 AMA 人群相当。应考虑对所有 AMA 患者进行常规产前监测。
