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      Asociación entre prematuridad y embarazadas en edad avanzada

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          Abstract

          Objetivo: Determinar la asociación entre prematuridad y embarazadas con edad mayor o igual a 35 años. Método: La muestra fue de 1 863 embarazadas (Casos: 620, Controles: 1 243). La variable de exposición fue edad ≥ 35 años y la de resultado prematuridad (gestación < 37 semanas, según la OMS). Para determinar el modelo parsimonioso se utilizó la prueba de máxima de verosimilitud. Ambiente: Ciudad Hospitalaria “Dr. Enrique Tejera” y Maternidad del Sur, Valencia. Resultados: La evaluación cruda de la asociación mostró un odds ratio (OR) de 2,07 (IC95 % = 1,6 a 2,6 P = 0,00001). La multiparidad condicionó modificación del efecto. La embarazada añosa nulípara tiene incremento del riesgo de prematuridad (OR = 4,5; IC95 % = 1,3 a 15,5 P = 0,01). Por el contrario, en la añosa multípara, la asociación no es estadísticamente significativa (OR = 1,3; IC95 % = 0,8 a 2,1 P = 0,1). Conclusiones: El embarazo en las mujeres añosas aumenta el riesgo de parto prematuro y este riesgo se incrementa si la mujer es primigesta.

          Translated abstract

          Objective: To determine the association between prematurity and 35 years old pregnant women or more. Method: The sample was of 1 863 pregnant women (Cases: 620, Controls: 1 243). The exposition variable was age ≥ 35 years old and of the outcome variable was prematurity (gestation < 37 weeks, according to OMS). For determination of the parsimonious model the likelihood ratio test was used. Setting: Ciudad Hospitalaria “Dr. Enrique Tejera” and Maternidad del Sur, Valencia. Results: Crude evaluation of the association showed an odds ratio (OR) of 2.07 (IC95 % = 1.6 to 2.6; P = 0.00001). Multiparity conditioned modification of the effect. Nuliparous older pregnant women has a higher risk of prematurity (OR = 4.5; IC95 % = 1.3 to 15.5; P = 0.01). On the contrary, in the older multiparous pregnant women, the association was no statistically significant (OR = 1.3; IC95 % = 0.8 to 2.1; P = 0.1). Conclusions: Pregnancy in older women has an increase risk of preterm labor and this risk increase if the woman is primigravida.

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          Delayed childbearing and the outcome of pregnancy.

          Whether women who delay childbearing are at increased risk for adverse outcomes of pregnancy is of concern because of the growing proportion of first births to older women. We assessed the effect of advancing maternal age on the outcome of pregnancy in first births in a hospital-based cohort study of 3917 private patients who were 20 years of age or older with a singleton gestation. There was a slight elevation in the risk of having a low-birth-weight infant among women who were 35 years of age or older (adjusted odds ratio, 1.3; 95 percent confidence interval, 0.9 to 1.9) as compared with the risk among women 20 to 29 years of age. However, there was no evidence that women between 30 and 34 or those 35 and older had an increased risk of having a preterm delivery or of having an infant who was small for gestational age, had a low Apgar score, or died in the perinatal period. In contrast, even after controlling for sociodemographic and medical risk factors, we found that women who were 35 or older were significantly more likely to have specific antepartum and intrapartum complications and those who were 30 or older were significantly more likely to have both cesarean sections and infants who were admitted to the newborn intensive care unit. This study suggests that although older primiparous women have higher rates of complications of pregnancy and delivery, their risk of a poor neonatal outcome is not appreciably increased.
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            Pregnancy in the sixth decade of life: obstetric outcomes in women of advanced reproductive age.

            As a result of oocyte donation, women in their sixth decade of life are now able to conceive and carry pregnancies to term. However, little is known about pregnancy outcomes in this population. To describe pregnancy outcomes in women aged 50 years or older who conceived after in vitro fertilization with donor oocytes. Retrospective analysis of cycles conducted at a US university assisted reproduction program during calendar years 1991-2001. Seventy-seven postmenopausal women with no chronic medical conditions (mean [SD] age, 52.8 [2.9] years; range, 50-63 years) who underwent 121 embryo transfer procedures (89 fresh and 32 frozen). Pregnancy outcomes were ascertained by chart review and telephone follow-up. Maternal and neonatal outcomes. There were 55 clinical pregnancies for a total pregnancy rate of 45.5%. The live birth rate was 37.2%. Of the 45 live births, 31 were singletons, 12 were twins, and 2 were triplets, for which the mean (SD) gestational ages at delivery were 38.4 (2.1) weeks, 35.8 (2.8) weeks, and 32.2 weeks, respectively. Mean (SD) birth weights were 3039 g (703 g), 2254 g (581 g), and 1913 g, respectively. Apgar scores at 1 and 5 minutes were 8.2 (0.9) and 9.1 (0.5), respectively. Of singletons, 68% were delivered by cesarean, and all multiples were delivered by cesarean. Mild preeclampsia was noted in 25% of patients and severe preeclampsia in 10%. Gestational diabetes required diet modification in 17.5%, and 2.5% required insulin. Appropriately screened women aged 50 years or older can successfully conceive via oocyte donation and experience similar pregnancy rates, multiple gestation rates, and spontaneous abortion rates as younger recipients. During pregnancy, they appear at increased risk of preeclampsia and gestational diabetes. A majority can expect to deliver via cesarean. However, there does not appear to be any definitive medical reason for excluding these women from attempting pregnancy on the basis of age alone.
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              Pregnancy outcome at age 40 and older.

              Our purpose was to examine pregnancy outcomes among women age 40 or older. Between January, 1997 and December 1999, we performed a case-control study compared pregnancy outcomes of 468 patients delivered at our hospital at > Or = 40 years old with outcomes in a control group consisting of the next two deliveries of women with ages 20 to 29 years. Retrospective analysis of the antepartum and intrapartum records was done to compare clinical outcome. Approximately 25,356 women delivered during the study period, and 468 (1.8%). Of these women were at age 40 or older. Of this latter group, 50 (10.7%) were nulliparous. Mean birthweight of infants delivered by older nulliparous women was significantly lower than that among nulliparous controls (3,210 +/- 5 vs. 3,320 +/- 1 g), whereas mean birth weight in the group of older multiparous was not different than that among younger multiparous controls (3,370 +/- 1 vs. 3,365 +/- 4 g). Gestational age at delivery was significantly lower among older nulliparous, and multiparous compared with nulliparous and multiparous younger controls. Older women were at increased risk for cesarean delivery (nulliparous 18%; multiparous 14%) compared with nulliparous and multiparous younger control groups (nulliparous 8%; multiparous 6%). In the study group, the operative vaginal delivery rate was higher than that of the control group. The study groups were more likely to develop gestational diabetes, preeclampsia, and placenta praevia. Older nulliparous had an increased incidence of malpresentation, abnormal labour patterns, special care baby unit admission (SCBU), and low 1-minute Apgar score. Older multiparous were more likely to experience birth asphyxia, premature rupture of membranes, and antepartum vaginal bleeding. Nulliparous women age 40 or over have a higher risk of operative delivery than do younger nulliparous women. This increase occurs in spite of lower birth weight and gestational age and may be explained by the increase incidence of obstetric complications. Although maternal morbidity was increased in the older women, the overall neonatal outcome did not appear to be affected.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                og
                Revista de Obstetricia y Ginecología de Venezuela
                Rev Obstet Ginecol Venez
                Sociedad de Obstetricia y Ginecología de Venezuela (Caracas )
                0048-7732
                January 2007
                : 67
                : 1
                : 15-22
                Affiliations
                [1 ] Universidad de Carabobo
                Article
                S0048-77322007000100005
                3592f327-2ce1-4eda-940d-b4517249cff0

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Venezuela

                Self URI (journal page): http://www.scielo.org.ve/scielo.php?script=sci_serial&pid=0048-7732&lng=en
                Categories
                OBSTETRICS & GYNECOLOGY

                Obstetrics & Gynecology
                Prematurity,Older pregnant woman,High risk pregnancy,Prematuridad,Embarazadas añosas,Embarazo de riesgo

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