To Detect Outcome of Pregnancy in Advanced Maternal Age among Pakistani Women

Aim: To examine the obstetrical outcomes among primiparous and multiparous Pakistani advanced maternal age women. Methods: A retrospective cohort study conducted at teaching hospitals of KVSS Site Hospital Karachi. From the hospital records, obstetrical characteristics of 585 consecutive women aged 40 or above who delivered from January 2009 to December 2013 were compared with those of 1816 younger mothers aged 20 to 29 years as control cases. Associations betweenparticular obstetrical variables and maternal age were measured with the contigency X-2 test or two-tailed Fisher exact test. Results: Advanced maternal ageprimiparous and multiparous were more expected to undertake cesarean delivery than were their younger counterparts (38.5% vs 13.5%, RR=2.85, p<0.05 and 16.1% vs 9.1%, RR=1.76, p<0.05). Older multiparous women had increased incidence of preeclampsia/eclampsia (2.4% vs 0.6%, RR=4, p<0.01); antepartum hemorrhage (1.8% vs 0.8%, RR=2.25, p<0.01); fetal distress (3.5% vs 1.3%, RR=2.69, p<0.01); fetal death (3.5% vs 1.6%, RR=2.18, p<0.05); postpartum hemorrhage (2.4% vs 1.2%; RR=2, p<0.05); preterm delivery (12% vs 9.2%, RR=1.30, p<0.05); low birth weight (11% vs 7.7%, RR=1.42, p<0.05); admission to special care neonatalogy unit(14.1% vs 10.2%, RR=1.38, p<0.05); low Apgar scores at 1min and 5min; and perinatal mortality (3.5% vs 1.6, RR=2.18, p<0.05). Conclusion: The results are in concordance with the view that increased risk of adverse perinatal outcome with advanced maternal age is indirectly related to age through the increased risk of obstetrical complications associated with age. Risk to cesarean delivery increases with advance maternal age. Increased risk of antepartum and intra partum complications among multiparous advanced maternal age women were associated to adverse perinatal outcome.