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高龄女性不孕和妊娠的管理

Author
Ruth C Fretts, MD, MPH
Section Editor
Louise Wilkins-Haug, MD, PhD
Deputy Editor
Kristen Eckler, MD, FACOG
Translators
于学文, 主任医师

引言

有许多妊娠都是意外妊娠，因此可能不是在处于最佳状况下(如控制不良的糖尿病、暴露于致畸因素)妊娠，所以所有育龄期女性都应接受孕前咨询。 (参见“孕前就诊”)

推迟生育的女性，发生不孕和某些妊娠并发症的风险升高。为所有育龄期女性提供关于高龄妊娠的产科风险的信息，能够帮助她们做出关于生育时机的知情决策。

女性应当知道，从32岁左右受孕几率就开始明显下降，并且随着年龄增长，共存内科疾病和妊娠并发症越来越常见。这些并发症包括异位妊娠、自然流产、胎儿染色体异常、某些先天性异常、前置胎盘、妊娠期糖尿病、子痫前期和剖宫产。这些并发症可能导致早产。围产期的死亡风险也有升高。 (参见“女性高龄对生育力和妊娠的影响”)

应该将这些风险与可能支持推迟妊娠的职业问题和其他个人问题进行权衡。然而，推迟妊娠也有一些优势，例如，年龄较大的夫妇往往比他们较年轻时在情感上更加成熟，经济上也更为稳定。

生育力的评估

许多专家建议，35-40岁女性如在6个月无保护性生活后仍未怀孕，则应进行生育力评估，而40岁以上的女性应尽快进行评估[1,2]。如女性伴侣有以下病史，也应在早于6个月时就开始进行评估：月经稀发/闭经、盆腔感染、盆腔手术、化疗、放疗或子宫内膜异位症。 (参见“女性不孕症的评估”)

           

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Literature review current through: 2017-06 . | This topic last updated: 2017-04-19.
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