Department of Obstetrics and Gynaecology, Kabale School of Medicine, Kabale University, P.0 Box 317, Kabale, Uganda.
Department of Physiology, Mbarara University of Science and Technology, Mbarara, Uganda.
BMC Pregnancy Childbirth. 2024 May 7;24(1):348. doi: 10.1186/s12884-024-06557-1.
Mothers of advanced age, defined as pregnant women aged ≥ 35 years at the time of giving birth, are traditionally known to be associated with increased risks of adverse maternal outcomes. We determined the prevalence of adverse maternal outcomes and associated factors among mothers of advanced age who delivered at Kabale Regional Referral Hospital (KRRH), in Southwestern Uganda.
We conducted a cross-sectional study at the Maternity Ward of KRRH from April to September 2023. We consecutively enrolled pregnant women aged ≥ 35 years during their immediate post-delivery period and before discharge. We obtained data on their socio-demographic, obstetric, medical characteristics and their maternal outcomes using interviewer-administered questionnaires. We defined adverse maternal outcome as any complication sustained by the mother that was related to pregnancy, delivery and immediate post-partum events (obstructed labour, antepartum haemorrhage, mode of delivery [cesarean or vacuum extraction], postpartum haemorrhage, hypertensive disorders of pregnancy, preterm or postdate pregnancy, anemia, premature rupture of membranes, multiple pregnancy, and maternal death). A participant was considered to have an adverse outcome if they experienced any one of these complications. We identified factors associated with adverse outcomes using modified Poisson regression.
Out of 417 participants, most were aged 35-37 years (n = 206; 49.4%), and had parity ≥ 5 (65.5%). The prevalence of adverse maternal outcomes was 37.6% (n = 157, 95%CI: 33.1-42.4%). Common adverse maternal outcomes included caesarian delivery (23%), and obstructed labour (14.4%). Other complications included anemia in pregnancy (4.5%), chorioamnionitis (4.1%), preterm prelabour rupture of membranes (3.9%), and chronic hypertension and preeclampsia (both 2.4%). Factors associated with adverse maternal outcomes were precipitate labour (adjusted prevalence ratio [aPR] = 1.95, 95%CI: 1.44-2.65), prolonged labour, lasting > 12 h (aPR = 2.86, 95%CI: 1.48-3.16), and chronic hypertension (aPR = 2.01, 95%CI: 1.34-3.9).
Approximately two-fifth of the advanced-aged mothers surveyed had adverse outcomes. Mothers with prolonged labour, precipitate labour and chronic hypertension were more likely to experience adverse outcomes. We recommend implementation of targeted interventions, emphasizing proper management of labor as well as close monitoring of hypertensive mothers, and those with precipitate or prolonged labor, to mitigate risks of adverse outcomes within this study population.
传统上认为，高龄产妇是指在分娩时年龄≥35 岁的孕妇，她们与不良母婴结局的风险增加有关。我们确定了在乌干达西南部卡巴莱地区转诊医院（KRRH）分娩的高龄产妇的不良母婴结局的患病率和相关因素。
我们于 2023 年 4 月至 9 月在 KRRH 的产科病房进行了一项横断面研究。我们连续招募了分娩后立即在出院前的年龄≥35 岁的孕妇。我们使用访谈者管理的问卷获得了她们的社会人口统计学、产科、医疗特征以及母婴结局的数据。我们将不良母婴结局定义为与妊娠、分娩和产后即刻事件（产程延长、产前出血、分娩方式[剖宫产或真空提取]、产后出血、妊娠高血压疾病、早产或过期妊娠、贫血、胎膜早破、多胎妊娠和产妇死亡）相关的任何母亲并发症。如果一名参与者经历了其中一种并发症，则被认为有不良结局。我们使用修正后的泊松回归来确定与不良结局相关的因素。
在 417 名参与者中，大多数年龄在 35-37 岁（n=206；49.4%），且有≥5 次分娩（65.5%）。不良母婴结局的患病率为 37.6%（n=157，95%CI：33.1-42.4%）。常见的不良母婴结局包括剖宫产（23%）和产程延长（14.4%）。其他并发症包括妊娠贫血（4.5%）、绒毛膜羊膜炎（4.1%）、早产未足月胎膜早破（3.9%）和慢性高血压和子痫前期（均为 2.4%）。与不良母婴结局相关的因素包括急产（调整后的患病率比[aPR]=1.95，95%CI：1.44-2.65）、产程延长（持续时间>12 小时）（aPR=2.86，95%CI：1.48-3.16）和慢性高血压（aPR=2.01，95%CI：1.34-3.9）。
大约五分之二的调查高龄产妇出现了不良结局。产程延长、急产和慢性高血压的产妇更有可能经历不良结局。我们建议实施有针对性的干预措施，强调适当管理产程以及密切监测高血压产妇和急产或产程延长的产妇，以降低该研究人群中不良结局的风险。
