Department of Obstetrics and Gynecology, Flevoziekenhuis, Almere, the Netherlands.
Emergency Department, Dijklander Ziekenhuis, Purmerend and Hoorn, the Netherlands.
Acta Obstet Gynecol Scand. 2024 May;103(5):927-937. doi: 10.1111/aogs.14765. Epub 2024 Jan 12.
As maternal age during pregnancy is rising all over the world, there is a growing need for prognostic factors that determine maternal and perinatal outcomes in older women.
This study is a retrospective cohort study of women aged 40 years or older at the time of delivery in four Santeon hospitals across the Netherlands between January 2016 and December 2019. Outcomes were compared between women of 40-44 years (advanced maternal age) and 45 years and older (very advanced maternal age). Primary outcome was unplanned cesarean section, secondary outcomes included postpartum hemorrhage and neonatal outcomes. Multivariate regression analysis was performed to analyze predictive factors for unplanned cesarean sections in women who attempted vaginal delivery. Subsequently, a predictive model and risk scores were constructed to predict unplanned cesarean section.
A cohort of 1660 women was analyzed; mean maternal age was 41.4 years, 4.8% of the women were 45 years and older. In both groups, more than half of the women had not delivered vaginally before. Unplanned cesarean sections were performed in 21.1% of the deliveries in advanced maternal age and in 29.1% in very advanced maternal age. Four predictive factors were significantly correlated with unplanned cesarean sections: higher body mass index (BMI), no previous vaginal delivery, spontaneous start of delivery and number of days needed for cervical priming. A predictive model was constructed from these factors with an area under the curve of 0.75 (95% confidence interval 0.72-0.78). A sensitivity analysis in nulliparous women proved that BMI, days of cervical priming, age, and gestational age were risk factors, whereas spontaneous start of delivery and induction were protective factors. There was one occurrence of neonatal death.
Women of advanced maternal age and those of very advanced maternal age have a higher chance of having an unplanned cesarean section compared to the general obstetric population in the Netherlands. Unplanned cesarean sections can be predicted through use of our predictive model. Risk increases with higher BMI, no previous vaginal delivery, and increasing number of days needed for cervical priming, whereas spontaneous start of labor lowers the risk. In nulliparous women, age and gestational age also increase risk, but induction lowers the risk of having an unplanned cesarean section.
随着全球范围内孕妇年龄的增长，人们越来越需要预测因素来确定年龄较大的女性的母婴和围产期结局。
本研究是一项回顾性队列研究，纳入了 2016 年 1 月至 2019 年 12 月期间在荷兰四个 Santeon 医院分娩时年龄在 40 岁或以上的女性。比较了 40-44 岁（高龄产妇）和 45 岁及以上（超高龄产妇）女性的结局。主要结局为无计划剖宫产，次要结局包括产后出血和新生儿结局。采用多变量回归分析评估尝试阴道分娩的女性中无计划剖宫产的预测因素。随后，构建预测模型和风险评分以预测无计划剖宫产。
分析了 1660 名女性的队列；平均产妇年龄为 41.4 岁，4.8%的女性年龄为 45 岁及以上。在这两个组中，超过一半的女性以前没有阴道分娩过。在高龄产妇中，21.1%的分娩行无计划剖宫产，超高龄产妇中 29.1%行无计划剖宫产。有四个预测因素与无计划剖宫产显著相关：较高的体重指数（BMI）、无阴道分娩史、分娩自发性启动和宫颈成熟所需天数。从这些因素构建了一个预测模型，曲线下面积为 0.75（95%置信区间为 0.72-0.78）。在初产妇中的敏感性分析表明，BMI、宫颈成熟天数、年龄和孕周是危险因素，而自发性分娩和引产是保护因素。有一例新生儿死亡。
与荷兰普通产科人群相比，高龄产妇和超高龄产妇行无计划剖宫产的几率更高。通过使用我们的预测模型，可以预测无计划剖宫产。BMI 较高、无阴道分娩史和宫颈成熟所需天数增加，风险增加，而自发性分娩降低风险。在初产妇中，年龄和孕周也会增加风险，但引产会降低无计划剖宫产的风险。
