PLD.06 Obstetric outcomes of pregnancies in women over 40 years of age in an inner London hospital

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Abstract

Introduction

Advanced maternal age has been associated with increased risk of stillbirth and obstetric complications.1 We aimed to document our local experience by comparing the mode of delivery and outcomes in our hospital for women aged over 40 years with those of younger women.

Methods

Retrospective analysis of 1 year’s intrapartum data from Homerton University Hospital (November 2012 to October 2013). Primary outcome: mode of delivery; secondary outcomes: maternal and fetal complications, comparing women aged over 40 at booking with those under 40.

Results

During 1 year there were 5531 deliveries, 193 (3.5%) for women over 40 years at booking. Elective caesareans section (CS) rates were higher amongst older women compared to younger women (23% vs. 7%, p < 0.0001). Amongst those not undergoing elective CS, older women were less likely to have a spontaneous vaginal delivery (49% vs. 62%, p=0.04) and more likely to require a CS category 1–3 (38% vs. 23%, p < 0.0001). A higher proportion of older women had hypertension or pre-eclampsia (11.4% vs. 5.7%, p = 0.003). There were higher rates of pre-term birth (12% vs. 8%, p = 0.045) and low birthweight babies (17% vs. 8%, p < 0.0001). There were 4 stillbirths in the over 40 group (2% of deliveries), compared to 27 in the under 40 group (0.5% deliveries, p = 0.02).

Conclusions

These data support the evidence that risks associated with advanced maternal age include higher rates of caesarean section, pre-eclampsia, pre-term birth, low birthweight and stillbirth. This should be considered during workforce planning to ensure safe outcomes for women and babies.

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