The implications of older motherhood

Abstract

The Implications of Older Motherhood Aim: To evaluate differences in the delivery and perinatal outcomes of the parturient primiparous women >/35 years of age (at delivery) as compared to the parturient primiparous women between the ages of 20-29 years (at delivery), of the resident Maltese population delivering at the Central Delivery Suite, Mater Dei Hospital. Method: 133 participants were recruited between October 2010 and May 2011 (n=70 younger participants, n=63 older participants) of the primiparous parturients at the CDS of MDH. The participants were sampled by taking a time cross-section of the older parturients who matched the study criteria and for each a matching younger parturient during the same period. A data collection sheet similar to that used for the routine data collection of perinatal indicators across Europe was completed for each participant. Results: Univariate analysis found that 60.3% of the older mothers were delivered by lower segment caesarean section (LSCS) (elective and emergency) as compared to 34.3% of the younger mothers (p=0.02). These were also found to have a higher composite risk of antenatal complications (p=0.04) and episiotomy (p=0.02). The younger cohort was found to be associated with the increased presence of perineal lacerations in vaginal deliveries (p=0.02) and to have a significant predilection for inhalational and opiod analgesia during labour (p=0.019, 0.001 respectively). Multivariate analysis was performed taking into account common confounders. Associations with age persisted for the LSCS rate in the older cohort and the presence of perineal lacerations in the younger one. Discussion: The increased LSCS rate is well documented elsewhere. Some attribute this to a physiological disadvantage of the older parturient whilst others attribute this to physician bias. In view of the lack of statistical power, this study was unable to show the association of some well-documented complications with age. Conclusions: This research showed that the increased rate of LSCS in older primiparous parturients is likely to be inflated due to physician bias although further research involving a larger sample size is recommended to increase confidence in the results and to look more specifically at the declared cause for caesarean section.