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To compare the obstetrical and detailed neonatal outcomes of primipara of advanced maternal age conceiving two sequential singleton pregnancies by IVF with those of primipara conceiving twins by IVF. A retrospective study of all primiparous women aged ≤ 38 years and conceived by IVF who delivered sequential singletons or delivered twins at a single tertiary university affiliated medical center between 2011 and 2019. We performed two main comparisons: 1. First vs. second singleton pregnancies. 2. Two singleton pregnancies vs. twin pregnancies. Overall, there were 63 women with consecutive singleton IVF pregnancies. The median age was 40.0 at first pregnancy and 42.0 in the second pregnancy. Pregnancy and delivery complications rates did not differ significantly between the first and the second singleton pregnancies, including gestational hypertensive disorders (7 (11.1%) vs. 4 (6.3%), p = 0.530), gestational diabetes mellitus (13 (20.6%) vs 18 (28.5%), p = 0.410), intrauterine growth restriction (6 (9.5%) vs. 4 (6.3%), p = 0.744), or cesarean delivery (25 (39.7%) vs. 29 (46%), p = 0.589). Rates of delivery before 32 weeks gestation were similar for both first and second singleton pregnancies (1.6%, p > 0.999). The proportion of neonatal adverse outcome in both first and second singleton pregnancies groups was low and did not differ between the groups. Compared with women who delivered sequential singletons, women with twin pregnancies had significantly higher cesarean delivery rates (113 (83.7%) vs. 29 (46%), p

The prevalence of risk factors for pre-eclampsia has changed over time; however, little is known regarding how these changes have altered the specific contribution of each risk factor. We aim to identify trends in the contribution of different risk factors throughout different time intervals. We compared the prevalence and odds-ratio of different known risk factors for pre-eclampsia occurring in three equal population groups from 1988 to 2014. Data was retrieved from our medical center's perinatal database. A multivariable logistic regression model was employed to identify independent risk factors for pre-eclampsia. We evaluated changes in risk factors and their specific contribution to the occurrence of pre-eclampsia over time and a comparison of the prevalence and odds-ratios of chosen risk factors between the three time periods was performed. 295,946 pregnancies met the inclusion criteria; of those, 16,246 (5.5%) were complicated with pre-eclampsia with the incidence increasing from 8 to 11%. Chronic hypertension, systemic lupus erythematosus, pre-gestational diabetes mellitus, twin pregnancy, advanced maternal age and fertility treatments were found to be the strongest independent risk factors. While rates of twin pregnancies and pre-gestational diabetes mellitus have demonstrated a linear increase, fertility treatments demonstrated a linear decrease. Chronic hypertension and systemic lupus erythematosus resulted in a mixed trend. In our study, not only did the rates of different risk factors for pre-eclampsia change over the study period, the specific contribution of each risk factor for the occurrence of pre-eclampsia changed as well. Developing a better understanding of these trends might aid in our ability to predict this major complication and to improve maternal and fetal outcomes.

Data regarding the effect of post-partum bilateral tubal ligation (BTL) on future risk for ovarian cancer (OC) is lacking. In the current study, we aimed to evaluate the effect of BTL during cesarean delivery (CD) on the long-term risk for OC. A population-based cohort analysis of women above the age of 35 that underwent CD in their last delivery, comparing the long-term risk for OC between patients that had a Pomeroy excisional BTL and those that did not. OC diagnosis was pre-defined based on ICD-9 codes. Procedures occurred between the years 1991–2017. Kaplan–Meier survival curve was used to compare the cumulative incidence of OC over time and Cox proportional hazards model was constructed to control for confounders. During the study period 13,124 women met the inclusion criteria; 9438 (71.9%) of which had only CD and 3686 (28.1%) underwent CD with BTL. Despite the significantly higher incidence of maternal factors that might increase the long-term risk for OC in the BTL group (advanced maternal age, obesity, hypertensive diseases during pregnancy and diabetes mellitus), the cumulative incidence of OC cases was not significantly different between the two groups (Log-rank test p = 0.199). Likewise, when performing a Cox regression model controlling for maternal age, obesity, hypertensive diseases and diabetes, OC risk was not significantly different between the groups (adjusted HR 2.36, 95% CI 0.73–7.62; p = 0.149). Despite an increased incidence of known risk factors for OC, patients that underwent BTL during CD did not have increased long-term risk for OC.

To identify whether older primiparas have more complications than do women who continue to deliver children into their late reproductive age. Patients of at least 35 years of age at delivery were included. Within this cohort, data from primiparous and multiparous women were compared. This retrospective study was based on electronic medical records from a single academic center, with more than 7000 deliveries annually. The impact of parity on maternal complications was assessed using a multivariate logistic regression model that adjusted for baseline maternal characteristics and medical history. During the study period, there were 54 283 deliveries in our medical center. A total of 13,982 (25.7%) patients were at least 35 years old at delivery. The rate of twin pregnancy was higher in the primiparous group (1.9%) as compared to the multiparous group (0.8%, 95% CI 0.30–0.64, P

Purpose To determine if the common risks for breech presentation at term labor are also eligible in preterm labor. Methods A Finnish cross-sectional study included 737,788 singleton births (24–42 gestational weeks) during 2004–2014. A multivariable logistic regression analysis was used to calculate the risks of breech presentation. Results The incidence of breech presentation at delivery decreased from 23.5% in pregnancy weeks 24–27 to 2.5% in term pregnancies. In gestational weeks 24–27, preterm premature rupture of membranes was associated with breech presentation. In 28–31 gestational weeks, breech presentation was associated with maternal pre-eclampsia/hypertension, preterm premature rupture of membranes, and fetal birth weight below the tenth percentile. In gestational weeks 32–36, the risks were advanced maternal age, nulliparity, previous cesarean section, preterm premature rupture of membranes, oligohydramnios, birth weight below the tenth percentile, female sex, and congenital anomaly. In term pregnancies, breech presentation was associated with advanced maternal age, nulliparity, maternal hypothyroidism, pre-gestational diabetes, placenta praevia, premature rupture of membranes, oligohydramnios, congenital anomaly, female sex, and birth weight below the tenth percentile. Conclusion Breech presentation in preterm labor is associated with obstetric risk factors compared to cephalic presentation. These risks decrease linearly with the gestational age. In moderate to late preterm delivery, breech presentation is a high-risk state and some obstetric risk factors are yet visible in early preterm delivery. Breech presentation in extremely preterm deliveries has, with the exception of preterm premature rupture of membranes, similar clinical risk profiles as in cephalic presentation.

Our objective was to investigate the combinatorial effect of maternal age and second-trimester maternal lipid profiles for pregnancy complications. With 1:4 matching, this retrospective study selected 499 advanced maternal age women and 1996 younger controls. Logistic regression analysis was used to estimate the correlation between second-trimester lipid profiles [total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C)] and pregnancy complications [gestational diabetes mellitus (GDM), pregnancy-induced hypertension syndrome (PIH), preterm labor (PTL), and macrosomia]. Optimal cutoff points were determined by ROC curve analysis. In women aged 20–34 years, TG are a risk factor for PIH (OR 1.54, 95% CI 1.16–2.04) and PTL (OR 1.34, 95% CI 1.04–1.72). LDL-C was positively associated with macrosomia (OR 1.25, 95% CI 1.04–1.50), while HDL-C was negatively associated with PIH (OR 0.45, 95% CI 0.21–0.93). The optimal cutoff points for TG predicting PIH and PTL were separately ≥ 2.135 and 2.305 mmol/L. The optimal cutoff point for HDL-C identifying PIH was ≤ 1.995 mmol/L and for LDL-C identifying macrosomia was ≥ 3.425 mmol/L. As for advanced maternal age, only TG was an independent risk factor for PIH (OR 1.60, 95% CI 1.01–2.54), and its optimal cutoff point was ≥ 2.375 mmol/L. Second-trimester lipid profiles might predict pregnancy complications varied by maternal age. This suggested that individualized prenatal care strategies should be established for women with advanced and normal maternal age to prevent pregnancy complications.

To examine temporal trends in stillbirth and its associated risk factors in Taiwan. This was a population-based cohort study. Data were extracted from the Birth Certificate Application database. Singleton births at 28 or more gestational weeks were included. A total of 1,536,796 births, including 3741 stillbirths, were analyzed from January 2006 to December 2013. The stillbirth rate was 2.4 per 1000 births and there was no change in the stillbirth rate during the study period. The adjusted odds ratio (aOR) for stillbirth was 1.28 for maternal age between 35 and 40 years and 1.79 for maternal age ≥ 41 years, with 21–34 years as the reference. The risk for stillbirth increased in single women (aOR, 2.4), female baby (aOR, 1.08), small for gestational age (aOR, 6.34) and large for gestational age (aOR, 1.52) infants, and women with hypertension (aOR, 3.78), diabetes mellitus (aOR, 2.04), anemia (aOR, 1.65), and oligohydramnios or polyhydramnios (aOR, 2.46).Women with heart disease and maternal age ≤ 20 years had no significant association with stillbirth after adjusting for various risk factors. Although the rate of stillbirth was stable during the study period, the incidence of risk factors associated with stillbirth, such as advanced maternal age, hypertension, diabetes mellitus, and anemia, had increased over time. Understanding about the risk factors might change protocols and allow for earlier detection of problems and prevention of stillbirths. Prevention or management of risk factors should be undertaken to reduce stillbirth rate.

To compare pregnancy rates of oral ovarian hyperstimulation agents (clomiphene citrate (CC) and letrozole) versus injectable agents (gonadotropins) in intrauterine insemination (IUI) in the older reproductive age group with diminished ovarian reserve. A retrospective cohort study was performed among 210 women 38–43 years of age undergoing IUI with controlled ovarian hyperstimulation (COH) at a single academic institution between 2009 and 2018. A total of 335 IUI cycles met inclusion criteria. Gonadotropins were the most frequently used ovarian hyperstimulation agent (n = 264), followed by CC (n = 38) and letrozole (n = 33). Mean age of the cohort was 40.5 (±1.6) years (range 38–43) did not differ significantly among groups (p = 0.41). Mean AFC and number of mature follicles on day of ovulation trigger also did not differ among groups (p = 0.98, p = 0.10). Overall clinical pregnancy rate was 7.5% per cycle, and rates for CC, letrozole, and gonadotropins respectively were 5.3%, 9.1%, 7.5% per cycle (p = 0.347). There was one multiple gestation pregnancy (twins), which was in a patient stimulated with gonadotropins. This is the first study to compare CC, letrozole, and gonadotropins in older reproductive age women with decreased ovarian reserve. The findings reveal that COH/IUI in older women with decreased ovarian reserve is a viable option (clinical pregnancy rate of 7.5% per cycle), and suggest that oral stimulation agents may be the first-line option, with letrozole having conferred the highest clinical pregnancy rate, 9.1%, which is notable given the typical poor fecundability of this population. However, larger population studies are needed to support this.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive age women. The clinical symptoms of PCOS vary with female age, as older women tend to have lower hyperandrogenic symptoms and many regain regular cycles. In this study, we aimed to estimate the prevalence of PCOS among older women referred for fertility care, describe their clinical characteristics, and compare their reproductive outcomes to those of matched control group. A retrospective study conducted at a single reproductive center. All women aged ≥ 40, who were referred for in-vitro fertilization (IVF), between the years 2011–2015 were screened for possible inclusion. The PCOS diagnosis (was) made based on the Rotterdam criteria. The reproductive outcomes of the PCOS group were compared to those of matched control with tubal infertility. During the study period, 1427 women, aged 40 years and over, underwent a total of 2124 IVF cycles. Of these, 72 (5%) women were diagnosed with PCOS. In 69 (95.6%), the PCOS diagnosis was made by a combination of polycystic ovary morphology (PCOM) and anovulation. Compared to women with tubal factor infertility, women with PCOS needed lower doses of gonadotropins, had higher number of retrieved oocytes (16.6 vs. 10.4) and higher number of cycles with embryo cryopreservation (47 vs. 22.9%). This resulted in higher cumulative live birth in the PCOS group (26.3 vs. 15.2%, p = 0.04). PCOS comprised 5% of the infertility diagnosis in women aged ≥ 40; PCOM and anovulation were the most prominent features. The higher oocyte number resulted in improved cumulative live birth rate.

To study the association between the numbers of oocytes retrieved and the cumulative live birth rates (LBR) in women aged 35–40 years undergoing long GnRH agonist IVF/ICSI cycles. A total of 931 women aged 35–40 years who underwent their first cycle of IVF/ICSI treatment between January 2010 and December 2013 at Nanjing Drum Tower Hospital were identified and reviewed. The main endpoint of this study was the cumulative LBR after one complete oocyte retrieval, which included fresh and all subsequent frozen–thaw embryo transfer cycles. Odds ratios (OR) and 95% confidence interval (CI) for live birth were estimated by multivariate logistic regression analysis. Furthermore, all the women were divided into four groups based on the number of oocytes retrieved: 0–4, 5–9, 10–14 or ≥15 oocytes group. Variables were then compared among groups. We found that 634 out of the 931 patients (68.1%) achieved at least one live birth. The number of oocytes retrieved was an independent predictive factor for live birth, with OR 1.20 (95% CI 1.15–1.26) when adjusted for age (years), duration of infertility and Gn (gonadotrophin) doses. The cumulative LBR in the four different oocyte groups was 35.6, 68.8, 83.4 and 89.2%, respectively. When the 1–4 oocytes group was issued as a reference, the ORs for cumulative LBR gradually increased to 3.66, 6.74 and 11.77 in other three oocytes groups, respectively. The moderate–severe ovarian hyperstimulation syndrome (OHSS) rate was dramatically increased in the ≥15 oocytes group (6.9%) when compared to that in the 10–14 oocytes group (0.8%), while the cumulative LBR only increased 5.8% (from 83.4 to 89.2%). The ideal number of oocytes retrieved in women aged 35–40 years is 10–14 oocytes, which achieves a high cumulative LBR while maintaining an acceptable low OHSS rate.

Amniotic fluid embolism (AFE) is an unpredictable and unpreventable complication of maternity. The presentation may range from relatively subtle clinical events to sudden maternal cardiac arrest. However, the neglected diagnosis of non-classical form of AFE (atypical AFE) is very common. The aim of this study was to examine population-based regional data from Suzhou, China. Based on the analysis of all available case reports, we put forward an outline of atypical AFE and investigate whether any variation identified could be ascribed to methodology. Retrospective study from January 2004 to December 2013, 53 cases was identified from the database of Center for Disease Control (CDC) in the city of Suzhou. We investigated the presentations of atypical AFE and maternal characteristics with potential factors underlying AFE. Multiple-regression analysis was used to calculate adjusted odds ratios (ORs) and 95 % confidence intervals (CIs). The incidence of AFE was 6.91 per 100,000 deliveries (53/766,895). Seventeen deaths occurred, a mortality rate of 32 %. Atypical AFE may as the earlier stage or mild form of AFE, there was no death case in the study with timely remedy. The atypical AFE appear is obstetric hemorrhage and/or pulmonary and renal dysfunction postpartum. Hyperfibrinolysis and coagulopathy may the early laboratory findings of atypical AFE. Atypical and classical AFE shared the same risks, such as advanced maternal age, placental abnormalities, operative deliveries, eclampsia, cervical lacerations, and induction of labor. Staying alert to premonitory symptoms of AFE is critical to turn it to a remediable disease. Patient complaints such as breathlessness, chest pain, feeling cold, distress, panic, a feeling of nausea, and vomiting should elicit close attention. The management of a suspected episode of amniotic fluid embolism is generally considered to be supportive. Hysterectomy must be performed if there is further progression of symptoms. Due to advances in acute care, mortality has decreased in recent years, highlighting the importance of early detection and treatment.

To assess the effect of advanced maternal age on the obstetrics and neonatal outcome of twin pregnancies. A retrospective study of 716 dichorionic–diamniotic twin pregnancies delivered at our institute. The study population was divided into two groups: women aged 35–39 years (group A, n = 142) and women aged ≥ 40 years (Group B, n = 48). The control group consisted of women younger than 35 years (group C, n = 516). The rate of cesarean section (CS) was significantly higher among women older than 35 years compared to the control group (A 76.8% and B 87.5% vs C 65.7%, P = 0.001). Women older than 35 years were also at higher risk for developing hypertensive disorders (A 7.0%, B 14.6%, vs C 5.4%, P = 0.04). On multivariate regression analysis, maternal age was found to be independently associated with a higher rate of CS (odds ratio vs reference group C: group A 1.6, 95% CI 1.08–2.6; group B 3.2, 95% CI 1.3–7.8). There was no difference between the groups in the rate of neonatal complications. Women with twin pregnancy, older than 35 years, have a significantly higher rate of CS and hypertensive disorder. This rate increases with maternal age, with no increased rate of neonatal complications.

Delayed childbearing is increasingly common; hence, concerns emerge regarding potential for additional risks of delivery at advanced maternal age (AMA; ≥35 years). In this study, we sought to assess impact of AMA and parity on maternal and perinatal outcomes. In this retrospective single-center study (July 2005 to October 2011), we compared spontaneously-conceived singleton births of AMA mothers with spontaneously-conceived singletons of mothers aged 24–27 years. Maternal outcomes: incidence of diabetes, hypertension, and emergency cesarean sections (ECS). Neonatal outcomes: prematurity, birth weight, incidence of small or large for gestational age infants (SGA/LGA, respectively), low birth weight (LBW), and 5′-Apgar scores. Sub-groupings of maternal age were 35–38, 39–42, or 43–47 years; prematurity as

To examine the pregnancy outcomes of women45 years in a multi-ethnic population when compared to controls and to reflect on socio-demographic details of the older mothers.A retrospective cohort control study over an 8-year period in an inner city London hospital with multi-ethnic population. The influence of advanced maternal age (45 years at time of delivery) on fetal and maternal outcomes was assessed by comparing these women to controls (aged 20-30 years) matched for ethnicity, country of origin and parity.Data from 64 cases and 64 controls were compared. Ninety percent of the index group had undergone assisted conception. Mothers45 years had a fourfold increase in cesarean section (35/64 vs 8/64), a threefold increase in blood loss (669.2 vs 272.4 ml) (both p0.001) and were more likely to have preterm birth (12/64 vs 3/64) (p0.05). Only 5 % of the 64 women were born in the United Kingdom, 52 % were unemployed and 50 % were not fluent in English. Seventy-five percent of the study population were multiparous, 52 % of the pregnancies were unplanned and 90 % had conceived spontaneously.In an inner city immigrant population, older mothers45 years were more likely to have cesarean sections, postpartum hemorrhage and premature deliveries. Moreover, social and demographic factors suggest that late child bearing is influenced by cultural factors such as acceptance of large families and lack of contraception.

Very premature delivery is a major cause of infant morbidity and mortality. Obesity, diabetes and pregnancy hypertension are known risk factors for pregnancy complications. The study aimed to scrutinize differences of pregnancy complications in a cohort of very premature deliveries compared to a national group. In a multicenter study performed between January 2009 and December 2010 including 1,577 very low birth weight (VLBW) infants, we compared parental reported pregnancy problems of VLBW infants with a national cohort (KIGGS). We compared reported pregnancy complications to reasons for premature delivery and neonatal outcome within the group of VLBW infants. While parents of the national cohort reported pregnancy-induced hypertension in 8 %, parents of VLBW infants reported this complication more frequently (27 %). Mothers of the national cohort were significantly younger (1 year), suffered less from obesity, anaemia, diabetes. Regression analysis showed that hypertension (OR = 5.11) and advanced maternal age (OR = 1.03) increased the risk for premature birth. Women with hypertension were likely to experience a clinically indicated premature delivery, had more VLBW infants with a moderate growth restriction, but less multiples and their infants had less intraventricular haemorrhages grade 3 or 4. Otherwise, neonatal outcome was correlated with gestational age but not with the pregnancy complications diabetes, hypertension or obesity. Premature birth seems to be correlated to gestational hypertension and associated problems in about ¼ of VLBW infants. Further studies should focus on preventing and treating gestational hypertension to avoid premature delivery and associated neonatal morbidity.

To examine birthweight and other predictors of brachial plexus injury (BPI) among births complicated by shoulder dystocia. A retrospective cohort study of term births complicated by shoulder dystocia in California between 1997 and 2006. Birthweight at time of delivery was stratified into 500-g intervals. Women were further stratified by diabetes status, parity, and race/ethnicity. The perinatal outcome of BPI was assessed. This study included 62,762 deliveries complicated by shoulder dystocia, of which 3168 (5 %) resulted in BPI. The association between birthweight and BPI remained significant regardless of confounders. Each increasing birthweight interval was associated with an increasing risk of BPI compared with 3000–3499-g birthweight. Race/ethnicity, diabetes, and parity were also independently associated with BPI. Increasing birthweight increases the risk of BPI among births with shoulder dystocia, independent of advanced maternal age, race, parity, gestational diabetes, or operative vaginal delivery.

The purpose of the current study was to determine whether or not the quadruple test for screening Down syndrome is an effective method to replace direct amniocentesis in pregnant women ≥ 35 years of age.This study analyzed the screening performance of the quadruple test according to maternal age at delivery among subjects who had a quadruple screening test at 1 of 4 hospitals during a 5-year period and for whom data on fetal chromosomal abnormalities were available.The study population of 9,435 pregnant women was divided into 3 groups according to maternal age: 6,922 women were35 years of age; 2,284 were 35-39 years of age; and 229 women ≥ 40 years of age. The detection and false-positive rates of the quadruple screening test for Down or Edward syndrome in the 3 groups of women were 80 and 6.6%, 200 and 15.8%, and 100 and 35.3%, respectively.Under conditions in which first trimester screening test is not available, the quadruple screening test is a better choice than direct amniocentesis for pregnancies complicated by advanced maternal age. When providing genetic counseling, we need to explain the accurate detection and false-positive rates of the screening test according to maternal age.

To compare the delivery and neonatal outcome of IVF singleton pregnancies with those conceived spontaneously in primiparous women ≥35 years of age. Data were collected by the hospital’s obstetrics and pediatric staff at the time of examination, hospitalization, delivery and discharge. A total of 283 women with in vitro fertilization (IVF) singleton deliveries were matched according to ethnicity, age, gravidity, smoking habits, body mass index, weight gain in pregnancy, site and time of delivery with consecutive 283 women conceived spontaneously. The outcome measures were mode of delivery, birth weight, preterm birth and perinatal mortality. Cesarean delivery rate was more common in IVF pregnancies (39.9% vs. 25.1%; p

Objective To investigate the effect of advanced maternal age (AMA) separately in nulliparous and multiparous women on obstetric and perinatal outcomes in singleton gestations. Study design A historical cohort study on data from 6,619 singleton pregnancies between 2004 and May 2007 was performed. AMA was defined as 35 years and older. Obstetric and perinatal outcomes in AMA versus women younger than 35 years (non-AMA) were compared for both nulli- and multiparae with Student’s t-test and Chi-square test in univariate analysis. Multiple logistic regression analysis was performed to examine the independent effect of AMA. Results Out of 6,619 singleton pregnancies, the frequency of nulliparity was 42.7 and 33.4% of the parturients were of AMA. Among nulliparous women, AMA was significantly associated with a higher frequency of caesarean section both before labour (OR 2.26 with 95% CI 1.74–2.94), in labour (OR 1.44 with 95% CI 1.07–1.93), and more instrumental vaginal deliveries (ORs 1.49 with 95% CI 1.13–1.96). Among multiparous women, AMA was only significantly associated with a higher caesarean section rate before labour (ORs 1.42, 95% CI 1.19–1.69). There were no significant differences between the two age groups in the prevalence of other adverse obstetric outcomes and adverse perinatal outcomes. Conclusions Operative delivery is increased in AMA, including caesarean sections, as well as instrumental vaginal deliveries in nulliparous women. In multiparous women, however, only the rate of caesarean section before labour was increased. AMA had no significant effect on other adverse obstetric and perinatal outcomes irrespective of parity.

The present study was aimed to investigate perinatal outcome of elderly nulliparous patients. A retrospective study was performed comparing pregnancy outcomes of nulliparous patients at three age groups: less than 35 years (reference group), 35–40 years, and above 40 years. The linear-by-linear association test was used to examine linear association between advanced maternal age and adverse pregnancy outcomes. A multiple logistic regression model was used to control for confounders. Out of 45,033 nulliparous women with singleton gestations, 1,036 were of women over the age of 35, and 188 over 40. A significant linear association was documented between advanced maternal age and adverse outcomes, such as intra uterine growth restriction, low birth weight, congenital malformations, and perinatal mortality. Using a multiple logistic regression model, controlling for gestational age, IUGR and malformations, advanced maternal age was not found to be an independent risk factor for perinatal mortality (adjusted odds ratio = 1.04, 95% confidence interval 0.7–1.4). A significant linear association exists between advanced maternal age and adverse maternal and perinatal outcomes. Nevertheless, in our population, advanced maternal age is not an independent risk factor for perinatal mortality.

To identify risk factors for the development of severe perineal lacerations and to give recommendations for their prevention in nulliparous women.A retrospective case-control analysis of deliveries at our University Hospital was performed. Multiparae, Caesarean sections, twin pregnancies, fetal breech position and preterm deliveries were excluded. Univariate and multivariate step forward regression analyses were performed; correlations between contributors were further analyzed by Spearman Rank Correlation. Differences between the degree of lacerations and maternal age were further analyzed with Friedman ANOVA followed by Dunn's Multiple Comparison Test.A total of 2,967 deliveries fitted our inclusion criteria, 50 (1.7%) mothers had higher-grade lacerations. Mediolateral and median episiotomy, advanced maternal age, vaginal operative delivery, higher fetal birth weight and abnormal cephalic presentation were associated with severe lacerations.Advanced maternal age plays an important role in the development of anal sphincter tears in nulliparous women. Episiotomy and operative vaginal deliveries should be restrictively performed when possible. To identify further preventive approaches in patients with accumulated risk factors prospective randomized studies are needed.

Objective: The aim of this study was to identify maternal risk factors for early neonatal sepsis and perinatal outcome in a population of very low birth-weight newborns. Study design: During January 1995 to December 2000, 786 live preterm neonates were born in our institute with birth-weight ≤1,500 g. A cross-sectional study was designed and two groups were identified: 50 neonates who developed early neonatal sepsis and 736 neonates without early sepsis. Results: The prevalence of early sepsis among the neonates was 6.3% (50/786). The following maternal risk factors were significantly associated with early neonatal sepsis: advanced maternal age, high gravidity, the administration of multiple courses of prenatal steroids and tocolytic agents, (i.e., magnesium and indomethacin) and chorioamionitis with premature rupture of membranes. Using a multivariate analysis, the use of tocolytic drugs was found as an independent risk factor for early neonatal sepsis (OR=4.8; 95% CI 1.1–1.6; P=0.019) and so was low gestational age (OR 0.98; 95% CI 0.007–0.017; P=0.017). The following variables of the neonate were significantly associated with early neonatal sepsis: low birth-weight, umbilical blood pH of less than 7.2 and the use of oxygen. Conclusions: The use of tocolytic drugs and low gestational age are independent risk factors for early neonatal sepsis.

Objective: The aim of this study is to present pregnancy and perinatal outcomes of twin gestations in older women and compare them with that for younger women. Study design: We conducted a retrospective cohort study of twin pregnancies in our department between 1988 and 2003. The women were classified into two groups by maternal age: women of age 35 years and older (study group) and women less than 35 years (control group). Population characteristics, complications during pregnancy and delivery, and neonatal outcomes were assessed. The Student’s t-test, χ2 test, Fisher exact test, and binary logistic regression analysis were used to examine the relationship between maternal age and the different variables. Results: A total of 238 twin pregnancies were enrolled (study group, 57 women; control group, 181 women). Spontaneous conceptions were significantly higher in the control group (P

Between 1989 and 1994 first trimester transcervical chorionic villus sampling was offered to 158 patients after proper counselling. The gestational age range was 9-12 weeks. The most important indication was advanced maternal age (75.4%). Adequate sampling after two, and a maximum of three attempts, was achieved in 98% and 99.3% of patients respectively. After the first year of the study karyotyping using the direct method alone was successful in 96% of cases. The success of karyotyping cultures was 98%. Excluding one false positive result the rate of fetal karyotypic abnormalities was 4.8%. 5 spontaneous abortions occurred (3.2%), all in patients of advanced maternal age. Moderate or severe vaginal bleeding occurred in 6.7% of the patients. There was no case of chorioamnionitis.

From October 1989 through December 1993, 124 pregnant women (114 in the second trimester and 10 in the third trimester) underwent transabdominal chorionic villus sampling (CVS) for prenatal molecular or cytogenetic diagnosis. The mean gestational age was 18.2 weeks. Indications for CVS comprised single gene disease (72%), fetal anomalies detected by ultrasound (17%), advanced maternal age (6%), and previous siblings with chromosomal aberration (5%). Among the 89 fetuses at risk for single gene disease, 20 were diagnosed as affected by DNA analysis. Among the 35 fetuses at risk for chromosomal anomaly, 4 had trisomy, 3 had a 45, XO karyotype and 2 had a structural chromosomal abnormality. The miscarriage rate was 1.8% (2/114) and the spontaneous preterm birth rate was 2.4% (3/124). No maternal or other fetal complications occurred. This study suggested that second- and third trimester CVS is a safe and useful method for prenatal diagnosis.

The study was aimed to define trends, risk factors and perinatal outcome associated with shoulder dystocia (SD). A population-based study comparing all singleton deliveries with and without SD was conducted. Statistical analysis was performed using multiple logistic regression analysis. Shoulder dystocia complicated 0.2% (n = 451) of all deliveries included in the study (n = 240,189). The rate of SD declined from 0.4% in 1988 to 0.13% in 2009. Independent risk factors for SD in a multivariable analysis were fetal macrosomia (birth-weight ≥ 4 kg; OR = 16.1; 95% CI 13.2–19.6, P