Management of pregnancy in women of advanced age
- Ruth C Fretts, MD, MPH
Ruth C Fretts, MD, MPH
- Assistant Professor of Obstetrics & Gynecology
- Harvard Medical School
Women who delay childbearing are at increased risk of pregnancy complications, including ectopic pregnancy, spontaneous abortion, fetal chromosomal abnormalities, some congenital anomalies, placenta previa, gestational diabetes, preeclampsia, and cesarean delivery. Such complications may, in turn, result in preterm birth. There is also an increased risk of perinatal mortality. Benefits include that older couples tend to be more emotionally mature and financially stable than when they were younger. Providing information to all patients of child-bearing age about the obstetrical risks of advanced maternal age can help them make informed decisions about the timing of child-bearing.
This topic will address the management of pregnancy in women of advanced age, which is generally agreed upon as age ≥35 years. Related topics on the effects of advanced age on pregnancy and fertility are presented separately.
Advanced maternal age — The age cut-off for advanced maternal age (AMA) pregnancy is not uniformly defined. Historically, AMA was defined as maternal age ≥ 35 years based on the convergence of the risk of fetal Down syndrome and the risk of amniocentesis to assess for Down syndrome. Other studies have defined AMA as age 40 or greater, and a category of "very advanced maternal age" has been proposed for women ≥45 years or ≥50 years, depending on the study [1,2].
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- Advanced maternal age
- Very advanced maternal age and implications
- INCIDENCE OF BIRTHS TO OLDER WOMEN
- RISK OF MISCARRIAGE
- SPECIFIC PRENATAL CARE ISSUES
- First and second trimester
- Third trimester
- Risks of stillbirth versus delivery
- - Induction of labor
- SUMMARY AND RECOMMENDATIONS