Outcomes of Women age 40 or More Undergoing Cesarean Delivery or Trial of Labor After Cesarean [19OP]

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The purpose of this study was to evaluate United States maternal and neonatal outcomes in women age 40 or more undergoing cesarean delivery or trial of labor after cesarean delivery.


We conducted a secondary analysis using the MFMU Cesarean Registry database comparing women age 40 years or more at the time of delivery with those age less than 40 (control group). We excluded multiple gestations. Maternal and neonatal outcomes were compared and Poisson regression was used to adjust for confounders including race and type of delivery.


A total of 67,389 women met inclusion criteria, of which 2,436 were age >40 year old and 65,403 were <40 at delivery. The >40 group had higher rate of PRBC transfusion (aRR 1.75; 95% CI 1.20–2.56), maternal ICU admission (aRR 2.02; 1.41–2.89), bowel injury (aRR 3.65; 1.43–9.31), placenta accreta (aRR 1.92; 1.09–3.38) and classical uterine incision (aRR 1.59; 1.43–9.31) compared to the control group. Maternal death rates were the same in both groups (P=.30). NICU admission and length of stay (LOS) was significantly higher in the >40 group compared to the control group (aRR 1.17; 1.09–1.25, LOS P=.005). Birth weight was significantly smaller in size of neonates born to women >40 group compared to the control group (3165 grams versus 3214 grams, P=.002).


Women age 40 or more undergoing cesarean delivery or trial of labor after cesarean delivery are more likely to have maternal complications including intraoperative transfusion, maternal ICU admission, abnormal placentation and more complicated surgeries.

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