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Research question In women at advanced age of 43–45 years undergoing repeated IVF cycles with autologous oocytes, who has the highest chance for birth and who should be referred early to receive donor oocytes? Design A retrospective cohort study was conducted at a university hospital reproductive center. The computerized database of 394 women aged 43–45 undergoing 1528 non-donor IVF or ICSI cycles between 2010 and 2019 was analyzed. a decision tree was developed, enabling a comprehensive study of a set of clinical parameters and the expected outcomes. Results The analysis included the outcomes of 394 women undergoing a total of 1528 cycles. The cumulative clinical pregnancy rate was 15% (59/394) and the cumulative live birth rate was 8.4% (33/394). The decision tree developed to predict women that should be offered egg donation included age, poor ovarian response to stimulation, the number of top-quality embryos, dominant follicles, previous pregnancy or live birth, fertilized oocytes and BMI. The model showed that a good ovarian response in the first cycle was the best predictor for live birth (13.3% gave birth). However, among women with poor responses, 7.1% of those who were younger than 43.5 years gave birth, and none of the women who were older than 43.5 years did. Conclusion Women over 43.5 years old with less than four oocytes collected in their first IVF cycle should be offered ovum donation, since their live birth rate in subsequent cycles is negligible.

Objectives: To determine the cause of stillbirth after application of relevant condition at death (ReCoDe) classification system. Methods: This was a retrospective cross sectional study of 207 women diagnosed with stillbirth after 24 completed weeks of pregnancy at the Aga Khan University Hospital (AKUH), Karachi between 1st January 2015 and 31st December 2019. The primary objective was to find the cause of stillbirth according to the new classification of relevant condition at death (ReCoDe). Results: There were a total of 32413 live births and 207 stillbirths during the study period thus stillbirth rate of 6 per 1000 live births. In this study, 80% of women were in the age group of 20-35 years, 16% had advanced maternal age while 3.8% of women accounted for less than 20 years. Among the maternal factors; 54.5% cases were booked and the remaining were were un-booked cases. Pre-eclampsia was the most common associated maternal condition (14.9%). Fetal cause accounted for 34.7% of stillbirths and the fetal growth restriction (FGR) was the most common; 23.6%. After application of ReCoDe classification, in 81% of stillbirth cases associated condition were found and only 18.8% of cases were categorized unexplained. Conclusion: Application of ReCoDe classification is easy to understand and applicable, especially in low resource settings with associated causes identified in vast majority of cases. doi: https://doi.org/10.12669/pjms.38.1.4470 How to cite this:Kashif U, Bhamani S, Patel A, Shamsul Islam Z. Still Birth classification: Application of Relevant Condition at Death (ReCoDe) classification system in a tertiary care hospital of Pakistan. Pak J Med Sci. 2022;38(1):133-137. doi: https://doi.org/10.12669/pjms.38.1.4470 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Worldwide, there has been a trend toward later motherhood. Concurrently, the incidence of subfertility has been on the rise, necessitating conception using assisted reproductive technologies (ARTs). These pregnancies are considered high risk due to fetal complications such as antepartum stillbirth and growth restriction and maternal complications such as increase in maternal morbidity and mortality. Early induction of labor can help to mitigate these risks. However, this has to be balanced against the iatrogenic harms of earlier delivery to both the baby, including respiratory distress and NICU stay, and the mother who might experience longer labor and other complications such as uterine hyperstimulation. Induction of labor at 39 weeks is the optimal timing for preventing antepartum stillbirth and avoiding iatrogenic harm. Delivery by elective cesarean section is not advocated as its benefits in these patients are unclear compared with the short- and long-term complications of a major abdominal surgery.

The rising caesarean section (CS) rate is a complex issue, particularly in an increasingly heterogenous nulliparous population. The study aim was to stratify the CS rate in nulliparous women by age and BMI to determine if any difference existed. This was a retrospective review of CS procedures of nulliparous women in two centres in Ireland (2014 through 2017). Data were obtained for 17,177 women from the hospital databases and CS procedures determined for each age and BMI category. Significant differences were observed when CS rates were stratified in this manner. The CS rates for women 45 years (p

OBJECTIVES. The objective was to investigate maternal and pregnancy characteristics associated with neonatal encephalopathy (NE). STUDY DESIGN. We queried an administrative birth cohort from California between 2011–2017 to determine the association between each factor and NE with and without hypothermia treatment. RESULTS. From 3 million infants born at 35 or more weeks of gestation, 6,857 cases of NE were identified (2.3 per 1,000 births), 888 (13%) which received therapeutic hypothermia. Risk factors for NE were stronger among cases receiving hypothermia therapy. Substance-related diagnosis, preexisting diabetes, preeclampsia, and any maternal infection were associated with a two-fold increase in risk. Maternal overweight/obesity, nulliparity, advanced maternal age, depression, gestational diabetes or hypertension, and short or long gestations also predicted NE. Young maternal age, Asian race and Hispanic ethnicity, and cannabis related diagnosis lowered risk of NE. CONCLUSIONS. By disseminating these results, we encourage further interrogation of these perinatal factors.

Background and Objectives. To evaluate whether a negative association between chronic hepatitis B carrier status and hypertensive disorders in pregnancy could continue to be demonstrated in an endemic area with a changing prevalence for chronic hepatitis B infection. Study Design. A retrospective cohort of all deliveries in a single centre over a period of 20 years in a population with high prevalence for chronic hepatitis B carrier status was studied. Main Outcome Measures. The primary outcome was the prevalence of chronic HBV carrier status and gestational hypertensive disorders in pregnancy during the study period. The secondary outcome measures included the major risk factors for gestational hypertensive disorders. The overall association between HBV carrier status and gestational hypertensive disorders and the association with major risk factors were then evaluated. Results. In a total cohort of 87889 deliveries over a period of 20 years, the prevalence rate of HBV fell from around 10-11% to around 6-7% in the last 5 years of the study. A negative association between chronic HBV carrier status and all gestational hypertensive disorders could be demonstrated. An apparent protective effect of HBV carrier status was apparently more robust against preeclampsia than gestational hypertension, as the negative association with preeclampsia was consistently observed throughout the study period. A logistic regression model showed that advanced maternal age, multiple pregnancies, obesity, and significant medical disorders were positively correlated with gestational hypertensive disorders, while multiparity and positive HBV carrier status were negatively correlated. Conclusion. Chronic HBV carrier status appeared to have a protective effect against the development of preeclampsia and gestational hypertension in an endemic area with high HBV prevalence rates.

Background: To estimate the prevalence of macrosomia and contributing factors among pregnant women with diabetes in Ethiopia. Methods: The Cochrane, PubMed, Google Scholar, SCOPUS, Web of Science electronic databases and grey literature found in online university repositories were searched for primary studies reporting the prevalence of macrosomia (birth weight >= 4 kg, irrespective of gestational age) and/or at least one determinant factor using WHO diabetes diagnosis criteria were involved. Variations across the studies were checked using the I-2 statistic; funnel plot and Egger's test were used to assess publication bias. A weighted inverse random effect model was used to estimate the overall prevalence of macrosomia. Results: The overall prevalence of macrosomic newborns among pregnant women with diabetes [15.1% (95% CI: 9.0%, 21.2%)] was higher than the prevalence among non-diabetic mothers (3.9%). Maternal blood glucose level >100 mg/dl [AOR = 10.5: 95% CI: 5.9, 15.1] and >120 mg/dl [AOR = 8.8: 95% CI: 4.5, 13.0], lack of Antenatal Care (ANC) visit [AOR = 10.8: 95% CI: 6.0, 15.0], previous adverse birth outcomes and advanced maternal age [AOR = 3.5: 95% CI: 1.0, 5.9] were significantly associated with the prevalence of macrosomia at 95% CI. Conclusion: The pooled prevalence of macrosomia among pregnant women with diabetes was higher than the prevalence among non-diabetic pregnant women (3.9%). Advanced maternal age, previous adverse birth outcomes, lack of ANC and uncontrolled maternal plasma glucose level were independent predictors of macrosomia.

Objective: To identify and determine the frequency of complications in neonates with low birth weight. Methodology: This cross sectional study was conducted at Khairpur Medical College and Lady Willingdon Hospital, Khairpur Mirs from January 2018 to July 2021. Two hundred (n=200) neonates with low birth weight (

Background: Due to the choice of postponing motherhood, the average age of women giving birth in Poland has moved into older age groups. This study was conducted to assess pregnancy complications and birth outcomes in women of advanced maternal age (AMA, over 35 years of age) compared with women aged 35 years. Material and Methods: Data on births was obtained from two third-degree hospitals in Warsaw, Poland for the years 2017 – 2019. Maternal and perinatal outcomes for women of advanced maternal age (n = 3,766) were analyzed using Chi-square tests and the ANOVA Kruskal-Wallis test. Comparisons between the following age groups of women were conducted: age 35 (control group), 36 – 39, 40 – 44 and over 45 years of age. Results of the analysis are presented with unadjusted odds ratios, 95 percent confidence intervals and p-values. Results: The incidence of pregnancy-induced hypertension (PIH) was found to increase with age in the 36 – 39 (OR 1.76, CI 1.09 – 2.87), 40 – 44 (OR 2.72, CI 1.56 – 4.73) and in the over 45 (OR 6.34, CI 2.04 – 19.69) age groups. The risk of gestational diabetes was seen to increase in women aged 40 – 44 (OR 1.49, CI 1.13 – 1.97) and increases almost three times in women over the age of 45 (OR 2.88, CI 1.41 – 5.87). The frequency of births by Cesarean section was observed to increase by one quarter in the 36 – 39 age group (OR 1.26, CI 1.07 – 1.48), by half in the 40 – 44 age group (OR 1.5, CI 1.28 – 1.96) and almost three times in women over 45 (OR 2.88, CI 1.41 – 5.87). There was no statistical significance for the incidence of preterm delivery, induction of labor and postpartum anemia or the health status of newborns in the studied age groups. Conclusions: Maternal age of over 35 years old is an independent risk factor for higher rates of pregnancy and perinatal complications in the Polish population.

The increasing prevalence of advanced paternal age (APA) has mirrored the rise in maternal age. APA is associated with an increased risk of de novo pathogenic single-nucleotide variants, but this topic has been much less frequently discussed than advanced maternal age (AMA). To explore the awareness of pregnant women regarding paternal age effect (PAE) disorders, a self-administered questionnaire survey was conducted for pregnant women at their first prenatal visit before 17 weeks of gestation. A total of 120 valid respondents (95.2%) were included in the analyses. Of these, 63.3% of pregnant women were aware of PAE disorders. This was markedly lower than the 90.8% recognition of maternal age effect (MAE) disorders. One-third of women with awareness of MAE disorders were not aware of PAE disorders. Pregnant women who were parous, older than their male partners, with knowledge of prenatal testing prior to this pregnancy, and with experience of prenatal testing in a prior pregnancy were significantly more aware of PAE disorders than others. Awareness of PAE disorders was not associated with undergoing prenatal testing during the present pregnancy. Our results show that the prevalence of pregnant women’s awareness of PAE disorders was lower than that of MAE disorders. The current study served as a preliminary baseline of information about pregnant women’s awareness of PAE disorders. With the introduction of non-invasive prenatal testing, which has the potential to identify PAE disorders, these findings will help the development of a framework for comprehensive prenatal genetic counseling for APA pregnancies. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12687-021-00555-y.

Background:. Empiric therapy for patients with unexplained recurrent pregnancy loss (URPL) is not precise. Some patients will ask for assisted reproductive technology due to secondary infertility or advanced maternal age. The clinical outcomes of URPL patients who have undergone in vitro fertilization-embryo transfer (IVF-ET) require elucidation. The IVF outcome and influencing factors of URPL patients need further study. Methods:. A retrospective cohort study was designed, and 312 infertile patients with URPL who had been treated during January 2012 to December 2015 in the Reproduction Center of Peking University Third Hospital were included. By comparing clinical outcomes between these patients and those with tubal factor infertility (TFI), the factors affecting the clinical outcomes of URPL patients were analyzed. Results:. The clinical pregnancy rate (35.18% vs. 34.52% in fresh ET cycles, P = 0.877; 34.48% vs. 40.27% in frozen-thawed ET cycles, P = 0.283) and live birth rate (LBR) in fresh ET cycles (27.67% vs. 26.59%, P = 0.785) were not significantly different between URPL group and TFI group. URPL group had lower LBR in frozen-thawed ET cycles than that of TFI group (23.56% vs. 33.56%, P = 0.047), but the cumulative LBRs (34.69% vs. 38.26%, P = 0.368) were not significantly different between the two groups. The increased endometrial thickness (EMT) on the human chorionic gonadotropin day (odds ratio [OR]: 0.848, 95% confidence interval [CI]: 0.748–0.962, P = 0.010) and the increased number of eggs retrieved (OR: 0.928, 95% CI: 0.887–0.970, P = 0.001) were protective factors for clinical pregnancy in stimulated cycles. The increased number of eggs retrieved (OR: 0.875, 95% CI: 0.846–0.906, P

There is a higher incidence of infertility, chromosomal aberrations, poor results of in vitro fertilization, ectopic pregnancies, spontaneous abortion, preeclampsia, placenta previa, gestational diabetes mellitus, caesarean section, chronic diseases with higher rates of admission into intensive care units, and a higher rate of maternal mortality among women who delay pregnancy into advanced age. This is mainly due to socioeconomic causes as well as the increased use of contraceptives. Problems due to advanced maternal age arise also with egg donations. Only chromosome aberrations are related to the age of the donor. Paternal age also appears to play a significant role in the outcome of the pregnancy. However, opinions vary in the literature available. Counseling the couples should be addressed.

Aim: To determine the risks of pregnancy and to study the adverse maternal and fetal outcomes of pregnancy in advanced maternal age. Materials and Methods: This study was a retrospective cohort study. Which was conducted in the Department of Obstetrics and Gynaecology, Government Medical College, Kozhikode. Data were collected from Department Medical Records Library. Data consisted of study group with maternal age above 35 years and control group with age less than 35 years. Cases beyond 28 weeks of gestation, both primiparous and multiparous patients were included. Minimum 262 patients were included in each group. Gestational age, presentation, mode of delivery, indications for caesarean, maternal complications and fetal outcomes were analysed. Statistical analysis was done by SPSS16.0 statistical software. Results: In this study statistically significant difference in maternal complications like incidence of gestational diabetes, gestational hypertension and preterm labour were observed in advanced maternal age women. Conclusion: Increasing incidence of maternal complications both obstetric and medical were observed in the advanced age mothers (AMA). There was a significant increase in preterm labour, increased caesarean delivery, PROM, PPROM, gestational hypertension, gestational diabetes, VLBW babies, intrauterine death in these elderly mothers. Due to the increase and advances of infertility treatments has made it common for mothers to become pregnant even at late forties. Keywords: AMA, PROM, PPROM, VLBW.

AIM This study is to investigate the role of amniocentesis for prenatal diagnosis before and after the beginning of noninvasive prenatal testing (NIPT) in Japan. METHODS We performed a retrospective analysis of genetic amniocentesis at mid-trimester (15-20 gestational weeks) for fetal karyotype analysis at Nagoya City University between April 2006 and March 2020. The indications, test results, and the detection rate of fetal abnormal karyotype were compared before (phase 1, P1) and after (phase 2, P2) beginning of NIPT at April 2013. RESULTS A total of 2458 (P1: 1132, P2: 1326) amniocentesis were enrolled in this study. The most frequent indication was advanced maternal age in both phases (P1: 78.2% %, P2: 81.1%). In P2, 110 patients (8.3%) received amniocentesis after positive or nonreportable NIPT results. Other indications were fetal abnormal findings by ultrasounds (P1: 15.4%, P2: 17.7%), abnormal maternal serum screening results (P1: 8.0%, P2: 10%), previous child with fetal chromosome aberration (P1: 6.5%, P2: 3.5%), and translocation of either partner (P1:1.5%, P2: 2.1%). The detection rate for fetal chromosomal aberrations including all indications was significantly increased in P2 (15.9%, 95% CI 14.0-18.0) as compared to P1 (9.0%, 7.4-10.8). However, if the indication was only advanced maternal age, the positive detection rate kept low in both phases (P1: 5.2%, 3.7-7.1, P2: 4.2%, 2.9-5.9). CONCLUSION Since the initiation of NIPT, the detection rate of fetal chromosomal abnormalities was higher in this study, suggesting that amniocentesis cannot be strongly recommended for advanced maternal age alone.

Summary Background Preterm birth rates have increased significantly worldwide over the past decade. Few epidemiological studies on the incidence of preterm birth and temporal trends are available in China. This study used national monitoring data from China's National Maternal Near Miss Surveillance System (NMNMSS) to estimate the rate of preterm birth and trends between 2012 and 2018 in China and to assess risk factors associated with preterm birth. Methods In this observational study, data were sourced from the NMNMSS between Jan 1, 2012, and Dec 31, 2018. Pregnancies with at least one livebirth, with the baby born at 28 weeks of gestation or more or 1000 g or more birthweight were included. We estimated the rates of overall preterm, very preterm (born between 28 and 31 weeks’ gestation), moderate preterm (born between 32 and 33 weeks’ gestation), and late preterm (born between 34 and 36 weeks’ gestation) births in singleton and multiple pregnancies and assessed their trends over time. We used logistic regression analysis to examine the associations between preterm birth and sociodemographic characteristics and obstetric complications, considering the sampling strategy and clustering of births within hospitals. Interrupted time series analysis was used to assess the changes in preterm birth rates during the period of the universal two child policy intervention. Findings From Jan 1, 2012, to Dec 31, 2018, 9 645 646 women gave birth to at least one live baby, of whom 665 244 (6·1%) were born preterm. In all pregnancies, the overall preterm birth rate increased from 5·9% in 2012 to 6·4% in 2018 (8·8% increase; annual rate of increase [ARI] 1·3 [95% CI 0·6 to 2·1]). Late preterm births (8·8%; ARI 1·5% [0·9 to 2·2]) and very preterm births (13·3%; ARI 1·8% [0·5 to 3·0]) significantly increased from 2012 to 2018, whereas moderate preterm births did not (3·8%; ARI 0·3% [95% CI –0·9 to 1·5]). In singleton pregnancies, the overall preterm birth rate showed a small but significant 6·4% increase (ARI 1·0% [0·4 to 1·7]) over the 7 year period. In multiple pregnancies, the overall preterm birth rate significantly increased from 46·8% in 2012 to 52·7% in 2018 (12·4% increase; ARI 1·9% [1·2 to 2·6]). Compared with women who gave birth in 2012, those who gave birth in 2018 were more likely to be older (aged ≥35 years; 7·4% in 2012 vs 15·9% in 2018), have multiples (1·6% vs 1·9%), have seven or more antenatal visits (50·2% vs 70·7%), and have antepartum complications and medical disease (17·9% vs 35·1%), but they were less likely to deliver via caesarean section (47·5% vs 45·0%). Compared with the baseline period (January, 2012 to June, 2016), a higher increase in preterm birth was observed after the universal two child policy came into effect in July, 2016 (β=0·034; p=0·03). Interpretation An increase in preterm births was noted for both singleton and multiple pregnancies between 2012 and 2018 in China. China's strategic investment in maternal and neonatal health has been crucial for the prevention of preterm birth. Due to rapid changes in sociodemographic and obstetric factors related to preterm birth—particularly within the context of the universal two child policy—such as advanced maternal age at delivery, maternal complications, and multiple pregnancies, greater efforts to reduce the burden of preterm birth are urgently needed. Funding National Key R&D Program of China, National Health Commission of the People's Republic of China, China Medical Board, WHO, and UNICEF.

Introduction: This case report refers to 54 years old infertile woman who visit ACHARYA VINOBABHAVE RURAL HOSPITAL for her ARTHRITIS PROBLEM with her husband (age 61-year-old). During her treatment, she got to know about IVF/ART procedures. As she belongs to a rural area and is not so educated, she was not aware of this and start investigating it and found it interesting. After knowing about all these procedures, a new ray of hope was awakened in her that, she can also give birth to her baby after so much waiting and facing so much criticism by society as a barren woman. In the 36th week of gestation, one healthy baby girl has been delivered by Cesarean section. In this way, the faith between patient and doctor was built-up and inevitably, we can appreciate this case of postmenopausal gestation (Geriatric Pregnancy) As A Therapeutic Victory For Wardha Test Tube Baby Centre and for the patient as well. This infertile couple was not that financially strong and even this all procedure is too much unaffordable to them still after all these, their urge to having a baby is so high that, they invest financially as well as emotionally and also mother put her health in peril while going through IVF/ART procedure. Being an infertile woman, she has to face a lot, and in such conditions, women go through psychological torture, and from this depressive phase, many health issues arise. Main Symptoms and/or Important Clinical Findings: Menopausal woman, qualitative analysis of AMH show 0 ng/ml, means diminished ovarian reserve (DOR). The Main Diagnoses, Therapeutic Interventions, and Outcomes: The woman is pinpointed with primary infertility for 26 years. The couple suggested going for IVF/ICSI treatment with donor oocytes(frozen) and self-sperm sample, ICSI is performed and sequential embryo transfer is done and gets conceived in the first cycle of ART. As being a menopausal woman, the dose of oral intake of estrogen hormone tablets doubles as an HRT treatment. Conclusion: Intake of the double dose of estrogen orally (hormone replacement therapy, HRT) than the normal women whose age is not much and who is not menopausal, increases the endometrium thickness and its receptivity which helps the woman to conceive in the first cycle through ART.

Background Seizure control during pregnancy and obstetric outcomes are of important concerns for women with epilepsy (WWE) and their families. Advanced maternal age (≥35 years) shows a growing trend in the society with changes of lifestyle, which also occurs in diseased populations. The advanced maternal age is an independent factor for some unsatisfying obstetric outcomes. In this study we explored the seizure control and obstetric complications associated with advanced maternal age in WWE. Methods This study was based on the epilepsy pregnancy registry at West China Hospital. Patients with epilepsy in this registry who were aged 35 or older when starting pregnancy were included in this study. Their basic demographics and detailed information on epilepsy management and obstetric issues in all trimesters and during 1-year follow-up after birth were documented and reviewed. Data were processed by IBM SPSS version 22.0. The demographic characteristics, seizure frequency, treatment change, obstetric complications, and outcomes were analyzed and compared. Results Fifteen patients were included in this study, with an average age of 36.32 ± 2.39 years at pregnancy, and 73.33% of them were primiparas. The change of seizure frequency during pregnancy was not in a clear pattern, but there was an increased incidence of tonic-clonic seizures during the mid- and last trimesters. More than 20% of the patients had obstetric complications throughout the trimesters, including vaginal bleeding, hypothyroidism, and pre-eclampsia. The pre-eclampsia seemed extraordinarily complicated with other conditions. However, none of the complications were related with malformations or poor outcome of babies after 1-year follow-up. Conclusion Advanced maternal age combined with WWE is associated with frequent common obstetric complications. Future controlled studies with large sample sizes are needed to explore the related risks in comparison with other WWE and non-epileptic populations.

Even though reduction of neonatal mortality is needed to achieve Sustainable Development Goals 2030, advanced maternal age is still an independent and a substantial risk factor for different adverse perinatal outcomes, in turn causes neonatal morbidity and mortality. In Ethiopia, research has validated that advanced maternal age is a significant factor in adverse perinatal outcomes, but researches which addressed or estimated its adverse perinatal outcomes are limited, reported inconsistent result and specifically no study was done in the study area. Therefore, this study was aimed to compare adverse perinatal outcomes and its associated factors among women with adult and advanced maternal age pregnancy in Northwest Ethiopia. Comparative cross-sectional study was conducted in Awi Zone, public hospitals, Northwest Ethiopia. Systematic random sampling was employed to select 348 adult and 176 advanced aged pregnant women. Structured questionnaire were used to collect the data. The collected data were analyzed using Statistical Package for the Social Sciences version 25. Binary and multivariate logistic regressions were fitted to assess the association between adverse perinatal outcomes and explanatory variables. P-value less than 0.05 was used to declare statistical significance. Significant percentage of advanced aged women (29.1%) had adverse perinatal outcomes compared to (14.5%) adult aged women. Similarly, proportion low birth weight, preterm birth and low Apgar score were significantly higher among advanced maternal age. The odds of composite adverse perinatal outcomes were higher among advanced maternal age women when compared to adult aged women (AOR 2.01, 95% CI 1.06, 3.79). No formal education (AOR 2.75, 95% CI 1.27, 5.95), short birth interval (AOR 2.25, 95% CI 1.07, 4.73) and complications during pregnancy (AOR 2.12, 95% CI 1.10, 4.10) were also factors significantly associated with adverse perinatal outcomes. Being advanced maternal age is at higher risk for adverse perinatal outcomes compared to adult aged women. Maternal illiteracy, short birth interval and complications during pregnancy were also significantly associated with adverse perinatal outcomes. Access of equal education, provision of family planning and perinatal care (including early detection and management of complication) is recommended.

Objective To determine the cost-effectiveness of different fertility options in men who have undergone vasectomy in couples with a female of advanced maternal age (AMA). The options include vasectomy reversal (VR), sperm retrieval (SR) with in vitro fertilization (IVF), and the combination of VR and SR with IVF, which is a treatment pathway that has been understudied. Materials and Methods Using TreeAge software, a model-based cost-utility analysis was performed estimating the cost per quality-adjusted life years (QALY) in couples with infertility due to vasectomy and advanced female age over a period of one year. The model stratified for female age (35-37, 38-40, >40) and evaluated four strategies: VR followed by natural conception (NC), SR with IVF, VR and SR followed by failed NC and then IVF, and VR and SR followed by failed IVF and then NC. QALY estimates and outcome probabilities were obtained from the literature and average patient charges were calculated from high-volume centers. Results The most cost-effective fertility strategy was to undergo VR and try for NC (cost-per-QALY: $7,150 (35-37 y), $7,203 (38-40 y), and $7,367 (>40 y)). The second most cost-effective strategy was the “back-up vasectomy reversal”: undergo VR and SR, attempt IVF and switch to NC if IVF fails. Conclusion In couples with a history of vasectomy and female of AMA, it is most cost-effective to undergo a VR. If the couple opts for SR for IVF, it is more cost-effective to undergo a concomitant VR than SR alone.

Background: Advanced maternal age is an important predictor for maternal and neonatal outcomes such as maternal mortality, low birth weight, stillbirth, preterm birth, cesarean section and preeclampsia. Objective: To determine the association of advanced maternal age and adverse maternal and neonatal outcomes in Iranian pregnant women. Methods: In this hospital-based cross-sectional study, 5117 pregnant women from 103 hospitals in Tehran, Iran, were participated in the study in 2015. The required data were gathered from hospitals which equipped to the department of obstetrics and gynecology. Advanced maternal age was considered as an independent variable and unwanted pregnancy, preeclampsia, preterm birth, cesarean section and low birth weight were considered as interested outcomes. Results: In our study, the prevalence of advanced maternal age was 12.08%. Advanced maternal age was significantly associated with higher risk of unwanted pregnancy (OR: 1.39, 95% CI: 1.12-1.73), preterm birth (OR: 1.75, 95% CI: 1.28- 2.39) and cesarean section (OR: 1.34, 95% CI: 1.03-1.74). In our study, there was no significant relationship between advanced maternal age and preeclampsia but this relationship could be clinically important (OR: 1.48, 95% CI: 0.99-2.20, P=0.052), and there is no significant relationship between advanced maternal age and low birth weight (OR: 1.08, 95% CI: 0.67-1.74, P=0.736). Conclusion: Advanced maternal age is associated with higher risk of unintended pregnancy, preterm birth and cesarean section but our findings did not support advanced maternal age as a risk factor associated with low birth weight.

To determine the relationship between maternal age and labor induction duration among nulliparous women.This retrospective cohort study included nulliparous women with non-anomalous, term, singleton pregnancies undergoing labor induction with intact membranes at a tertiary-care academic hospital from January 2015 to April 2017. Maternal age was stratified as follows:25 years, 25-29 years, 30-34 years, 35-39 years, and ≥ 40 years. The primary outcome was induction duration, defined as the time the first induction agent was administered to time of birth. Secondary outcomes were cesarean delivery, cesarean indication, hemorrhage, blood transfusion, peripartum infection, composite neonatal morbidity, and induction duration among the subset of women who ultimately underwent cesarean. The data were analyzed using chi-squared and Fisher exact tests. Multivariable regression was used to adjust for maternal race/ethnicity, maternal body mass index, gestational age at start of induction, and induction indication. Hazard ratios were used to calculate induction duration among women who underwent cesarean delivery, stratified by age and adjusted by the same variables.Among the 955 patients included, the median induction duration was 32.3 h (interquartile range (IQR) 20.4-41.0 h). Women 40 years and older had a slight increase in induction duration (adjusted odds ratio (aOR) 1.03, 95% confidence interval (CI) 1.01-1.05) and a seven-fold increased risk of induction lasting 60 h or longer (adjusted relative risk (aRR) 7.3, CI 1.8-29.9) when compared to those under 25 years of age; otherwise, there was no association between maternal age and labor induction duration. There was no association between age and cesarean delivery, cesarean indication, hemorrhage, transfusion, peripartum infection, or adverse neonatal outcomes. Furthermore, there was no association between maternal age and induction duration even among women who ultimately underwent cesarean.We found no association between maternal age and induction duration for women under 40 years of age. For women 40 years of age and older, these was an increased risk of labor induction lasting 60 h or longer. Despite this, we found no association between maternal age and cesarean delivery or other adverse maternal or fetal outcomes.

Aims/Introduction The association between gestational diabetes mellitus (GDM) and adverse maternal and perinatal outcomes in twin pregnancies remains unclear. This study was undertaken to highlight risk factors for GDM in women with dichorionic (DC) twins, and to determine the association between GDM DC twins and adverse maternal and perinatal outcomes in a large homogeneous Taiwanese population. Materials and Methods A retrospective cross‐sectional study was carried out on 645 women with DC twins, excluding pregnancies complicated by one or both fetuses with demise (n = 22) or congenital anomalies (n = 9), who gave birth after 28 complete gestational weeks between 1 January 2001 and 31 December 2018. Univariable and multiple logistic regression analyses were carried out. Results Maternal age >34 years (adjusted odds ratio 2.52; 95% confidence interval 1.25–5.07) and pre‐pregnancy body mass index >24.9 kg/m2 (adjusted odds ratio 2.83, 95% confidence interval 1.47–5.46) were independent risk factors for GDM in women with DC twins. Newborns from women with GDM DC twins were more likely to be admitted to the neonatal intensive care unit (adjusted odds ratio 1.70, 95% confidence interval 1.06–2.72) than newborns from women with non‐GDM DC twins. Other pregnancy and neonatal outcomes were similar between the two groups. Conclusions Advanced maternal age and pre‐pregnancy overweight or obesity are risk factors for GDM in women with DC twins. Except for a nearly twofold increased risk of neonatal intensive care unit admission of newborns, the pregnancy and neonatal outcomes for women with GDM DC twins are similar to those for women with non‐GDM DC twins., Advanced maternal age and pre‐pregnancy overweight or obesity are risk factors for gestational diabetes mellitus in women with dichorionic twins. Except for a nearly two‐fold increased risk of neonatal intensive care unit admission of newborns, the pregnancy and neonatal outcomes for women with gestational diabetes mellitus with dichorionic twins are similar to those for women with non‐gestational diabetes mellitus with dichorionic twins.

Do women of racial minorities aged 40 years or older have similar reproductive and obstetric outcomes as white women undergoing IVF?A retrospective cohort study conducted at a single academic university-affiliated centre. The study population included women aged 40 years or older undergoing their first IVF cycle with fresh cleavage-stage embryo transfer stratified by racial minority status: minority (black or Asian) versus white. Clinical intrauterine pregnancy and live birth rate were the primary outcomes. Preterm delivery (37 weeks) and small for gestational age were the secondary outcomes. Odds ratios with 95% confidence intervals were estimated. P0.05 was considered to be statistically significant.A total of 2050 cycles in women over the age of 40 years were analysed, 561 (27.4%) of which were undertaken by minority women and 1489 (72.6%) by white women. Minority women were 30% less likely to achieve a pregnancy compared with their white (non-Hispanic) counterparts (adjusted OR 0.68, CI 0.54 to 0.87). Once pregnant, however, the odds of live birth were similar (adjusted OR 1.23, CI 0.91 to 1.67). Minority women were significantly more likely to have lower gestational ages at time of delivery (38.5 versus 39.2 weeks, P = 0.009) and were more likely to have extreme preterm birth delivery 24-28 weeks (5.5 versus 1.0%, P = 0.021).Minority women of advanced reproductive age are less likely to achieve a pregnancy compared with white (non-Hispanic) women. Once pregnancy is achieved, however, live birth rates are similar albeit with minority women experiencing higher rates of preterm delivery.

OBJECTIVE To investigate factors associated with unscheduled cesarean delivery at one urban tertiary medical center. METHODS A retrospective chart review was performed on 11 162 deliveries between 2009 and 2019. The dependent variable was unscheduled cesarean delivery. Covariates examined included time of delivery, as well as several maternal and pregnancy-related factors. RESULTS There were a total of 7037 (63.1%) vaginal, 1133 (10.1%) elective cesarean, and 2992 (26.8%) unscheduled cesarean deliveries. Independent factors associated with increased odds for unscheduled cesarean delivery included daytime delivery (odds ratio [OR] 1.29, 95% confidence interval [CI] 1.18-1.42, P

In order to find out to what extent ovarian aging could be compensated by the in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatments, a total of 4102 women above the age of 35 undergoing 6489 complete cycles from 2009 to 2015 with follow-up visits until 2017 were retrospectively analyzed. Cumulative live birth rates (CLBRs) across multiple IVF/ICSI cycles were compared in the study population stratified by age and ovarian reserve (classified by the POSEIDON criteria). Younger patients (aged between 35 and 40) could well benefit from repeat IVF treatments, with the optimal CLBRs ranging from 62%-72% for up to four complete cycles. However, the CLBRs sharply declined to 7.7%-40% in older patients (>40yrs). In light of ovarian reserve, the optimal-estimated-four-cycle CLBR of younger patients (35-40yrs) in POSEIDON group 2 could approached to those with normal ovarian response (non-POSEIDON), with 57.3%-70% versus 74.5%-81% respectively. However, the CLBR of older patients (>40yrs) in POSEIDON group 2 only reached 50% of their counterparts. Extending the number of IVF cycles beyond three or four is effective for advanced-aged women, especially in younger normal responders (non-POSEIDON) and unexpected poor/suboptimal responders (POSEIDON group 2). The real turning point at which female fecundity dropped after multiple IVF cycles is at the age of 40.

Objectives: to describe the profile of Brazilian Advanced Maternal Age (AMA) women (> 35 years) according to parity, as well as to analyze the role of parity in the relationship between AMA and mode of delivery. Methods: this is a cross-sectional study, based on the “Nascer no Brasil” (Born in Brazil) survey. The data were collected in 2011/2012. The chi-square test was performed to verify the association between parity and maternal, prenatal and delivery characteristics, maternal habits, pre-pregnancy diseases, maternal complications and obstetric history. Results: of the 2,510 puerperal AMA women, 20.2% were nulliparous, 54.4% had one or two previous births and 25.4% had three or more previous births. The nulliparous women had higher schooling, higher economic class and adequate BMI, were white; and had better maternal habits when compared to multiparous. However, they were also more submitted to cesarean section, although without reported complications. Conclusions: one cannot speak of AMA pregnant women as a homogeneous group in Brazil. There are inequalities that can be revealed via parity, since nulliparous women have maternal characteristics, habits and access to prenatal care and childbirth that are more advantageous than multiparous women.

Background and Objective: Chromosomal abnormalities are one of the genetic disorders caused by abnormal chromosome number or structure and can endanger multiple organs, morphology and function of the systems in the human body. This study aims to investigate the relationship between prenatal diagnosis indications and abnormal karyotypes to improve prenatal screening. Methods: The karyotype analyses were carried out on 4646 pregnant women with prenatal diagnosis indications referred to the first medical center of Chinese PLA General Hospital from 2012 to 2019. The incidence, distribution, and statistical features of chromosomal abnormality of different prenatal diagnosis indications were analyzed, and the relationships with the prenatal diagnosis indications were assessed. Results: A total of 351 fetal chromosomal abnormalities were detected in 4646 karyotypes, with an incidence of 7.6%. The chromosomal abnormality incidence in the single indication group, two indications group, and three indications group was 5.8%, 16.1%, and 70.0%, respectively, indicating a statistically significant difference (p Conclusion: Prenatal karyotype analysis of pregnant women with prenatal diagnosis indications can effectively prevent the birth of defective children. AMA, MSS and NIPT were the important indications for predicting abnormal karyotype. In addition, the number of prenatal diagnosis indications is highly correlated with chromosomal abnormalities.

Objective The present study aimed to determine the diagnostic value of prenatal chromosomal microarray analysis (CMA) for fetuses with several indications of being at high risk for various conditions. Materials and methods This retrospective analysis included 1256 pregnancies that were prenatally evaluated due to high-risk indications using invasive CMA. The indications for invasive prenatal diagnosis mainly included ultrasound anomalies, high-risk for maternal serum screening (MSS), high-risk for non-invasive prenatal tests (NIPT), family history of genetic disorders or birth defects, and advanced maternal age (AMA). The rate of clinically significant genomic imbalances between the different groups was compared. Results The overall prenatal diagnostic yield was 98 (7.8%) of 1256 pregnancies. Clinically significant genomic aberrations were identified in 2 (1.5%) of 132 patients with non-structural ultrasound anomalies, 36 (12.7%) of 283 with structural ultrasound anomalies, 2 (4.5%) of 44 at high-risk for MSS, 38 (26.6%) of 143 at high-risk for NIPT, 11 (3.8%) of 288 with a family history, and 7 (2.1%) of 328 with AMA. Submicroscopic findings were identified in 29 fetuses, 19 of whom showed structural ultrasound anomalies. Conclusion The diagnostic yields of CMA for pregnancies with different indications greatly varied. CMA could serve as a first-tier test for structural anomalies, especially multiple anomalies, craniofacial dysplasia, urinary defects, and cardiac dysplasia. Our results have important implications for genetic counseling.

Objective To elucidate the role of advanced maternal age (AMA) in determining the outcome of pregnancies complicated by SARS-CoV-2 infection. Methods Multinational cohort study included women with laboratory-confirmed SARS-CoV-2 infection from 76 centers in 27 different countries in Europe, United States, South America, Asia and Australia from 04 April 2020 till 28 October 2020. The primary outcome was a composite measure of maternal mortality and morbidity including admission to intensive care unit (ICU), use of mechanical ventilation (defined as intubation, need for continuous positive airway pressure, extra-corporeal membrane oxygenation), severe respiratory symptoms (including dyspnea and shortness of breath) or death. Results Eight hundred and eighty seven pregnant women were included in the study who were positive SARS-CoV-2 results by RT-PCR (reverse transcriptase-polymerase chain reaction) on their nasal and pharyngeal swab specimens (352 with and 652 with no AMA). The risk of composite adverse maternal outcome was higher in AMA group compared to that of under 35 years of age group, with an OR of 1.99 (95% CI 1.4–2.9; p=0.002). Likewise, women >35 years were also at higher risk of hospital admission (OR: 1.88, 95% CI 1.4–2.5; p

Background Nulliparity is considered to be a risk factor of preterm birth (PTB), low birth weight (LBW) and small for gestational age (SGA). With the new two-child policy launched in 2016, more Chinese women have delivered their 2nd baby. Yet few studies have assessed the impact of parity on adverse birth outcomes in China. This study aimed to examine the association between parity and risks of PTB, LBW and SGA in a Chinese population. The combined effects of maternal age and parity on adverse birth outcomes were also assessed. Methods This retrospective study included all non-malformed live births born during January 1, 2014 and December 31, 2018 in Chengdu, China. A total of 746,410 eligible live singletons with complete information were included in the analysis. Parity was classified into nulliparity (i.e. has never delivered a newborn before) and multiparity (i.e. has delivered at least one newborn before). Log-binomial regression analyses were applied to evaluate the association between parity and PTB, LBW and SGA. We further divided maternal age into different groups ( Results Multiparity was associated with reduced risks of PTB (aRR = 0.91, 95% CI: 0.89–0.93), LBW (aRR = 0.74, 95% CI: 0.72–0.77) and SGA (aRR = 0.67, 95% CI: 0.66–0.69) compared with nulliparity. In each age group, we observed that multiparity was associated with lower risks of adverse birth outcomes. Compared to nulliparous women aged between 25 and 29 years, women aged ≥35 years had greater risks of PTB and LBW, regardless of their parity status. In contrast, multiparous women aged ≥35 years (aRR = 0.73, 95% CI: 0.70–0.77) and those aged Conclusion Multiparity was associated with lower risks of all adverse birth outcomes. Special attention should be paid to nulliparous mothers and those with advanced age during antenatal care, in order to reduce the risks of adverse birth outcomes.

Objective The delay of childbearing in women has become a worldwide issue in recent decades. The application of assisted reproductive technology in women of advanced maternal age (AMA) is increasing. Evidence on the safety and outcomes of frozen embryo transfer (FET) compared with fresh embryo transfer (ET) in AMA women is still lacking. Therefore, the objective of the present study was to compare perinatal and maternal outcomes after autologous FET and fresh ET cycles in women of AMA. Study design A retrospective study of 1663 FET and 3964 fresh ET cycles in reproductive medical centers from 2009 to 2014. Women who aged ≥35 years and had clinical pregnancies after autologous frozen or fresh ET were included. The main perinatal outcomes included birth weight, gestational age, rates of preterm birth, macrosomia, low birth weight (LBW), and very low birth weight. The main maternal outcomes included rates of hypertensive disorders of pregnancy, gestational diabetes mellitus, and preterm premature rupture of the membranes. Results Women who underwent FET had an increased risk of hypertensive disorders of pregnancy [1.1 % vs. 0.4 %, adjusted OR (95 % CI): 2.76 (1.39−5.51); p = 0.004]. Singletons born after FET had significantly higher mean birth weight (3388.78 ± 538.47 vs. 3316.19 ± 549.08; p = 0.001). Furthermore, increased risk of macrosomia [13.5 % vs. 10.4 %, adjusted OR (95 % CI): 1.35 (1.07−1.71); p = 0.013] and decreased risk of LBW [3.6 % vs. 5.3 %, adjusted OR (95 % CI): 0.67 (0.45−1.00); p = 0.048] were found in singletons born after FET. Conclusions Perinatal risks of AMA patients are higher in FET than in fresh ET, including higher birth weight, risks of macrosomia in singleton births, and hypertensive disorders of pregnancy.

Background In the entire population, an aberrant right subclavian artery (ARSA) is closely associated with chromosomal abnormalities. ARSA with additional ultrasonic findings would increase risk of chromosomal abnormalities. The risk of fetal chromosomal abnormalities increased exponentially with the maternal age. These risks in the advanced maternal age (AMA) group are uncertain. This study aimed to determine the incidence of ARSA in Chinese AMA and non-AMA women and the frequency of aneuploidy among AMA and non-AMA women with ARSA. Methods This retrospective study included 13,690 singleton pregnancies, were divided into AMA and non-AMA groups. Integrated obstetric ultrasonic screening, biochemical screening, noninvasive prenatal screening, and fetal karyotype analysis were analyzed. Results The overall incidence of ARSA was 0.69%, with no difference between age groups. The incidence of chromosomal abnormalities in the AMA group (37 / 2860) was much higher than that of the non-AMA group. The risk of chromosomal abnormalities significantly increased with both ARSA detected and additional ultrasound findings. With combined ARSA and AMA, the likelihood of the incidence of chromosomal abnormalities increased. Chimerism (45X / 46XX) was found with isolated ARSA in AMA pregnancies. Conclusion There is a high prevalence of chromosomal abnormalities in fetuses of AMA women. ARSA increases the risk of chromosomal abnormalities in both age groups, especially combined with ARSA. When ARSA occurs in AMA women, it confers a high likelihood of chromosomal abnormalities.

Aim and background:Coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), how it affects pregnancy very little is known. To identify maternal and neonatal risks associated with COVID-19 in pregnancy and to describe outcome a matched case–control study was done. Materials and methods: In this study, COVID-19 reverse transcription polymerase chain reaction (RT-PCR) positive women who delivered from May 1, 2020, to August 31, 2020, were included. Cases were classified according to their severity and investigations. Controls were selected from COVID-19 negative women in a 1:1 ratio who delivered in the study period. Data were collected, analyzed in terms of maternal and neonatal outcomes. Results: Of the total 181 COVID-19 cases delivered during the study period, there were 97.23% mild, 2.76% moderate, and 0.55% severe cases. A total of 178 (98.34%) were diagnosed in the third trimester. More COVID-19 cases were from urban areas. Mean gestational age in the mild category was 38.1 weeks and the moderate/severe category was 37.5 weeks. Around 154 (85.08%) were asymptomatic. Cases had more medical and pregnancy morbidity than controls, which was statistically significant. About 52.49% of cases and 33% of controls had cesarean. Length of hospital stay was more in cases. Mean birth weight was 2.7 ± 0.59 kg in cases and 2.5 ± 0.56 kg in control. There were 7 stillbirths in each group. A total of 14 in cases and 16 in controls were transferred to the newborn intensive care unit (NICU). Conclusion: The majority of COVID-19 infected women who are asymptomatic are in the mild category and there are no adverse maternal and neonatal outcomes due to the disease. The adversity of maternal and neonatal outcomes depends on the severity and severity of the disease is dependent on advanced maternal age and presence of comorbidities.

Objective:We examined whether folic acid (FA) supplementation prevented congenital hydrocephalus (CH) in more than 200 000 births in China.Design:A large population-based cohort study.Setting:All births at 20 complete gestational weeks, including live births, stillbirths and pregnancy terminations, and all structural birth defects regardless of gestational week were recorded. The prevalence of births with CH was classified by maternal characteristics and FA supplementation. CH was diagnosed in accordance with code 742.3 of the International Classification of Diseases, Ninth Revision, Clinical Modification, while non-neural tube defect (NTD) CH refers to CH without anencephaly (740), spina bifida (741) or encephalocele (742·0).Participants:A total of 247 831 pregnant women who delivered with known outcomes were included.Results:A total of 206 cases of CH (0·83 per 1000 births) and 170 cases of non-NTD CH (0·69 per 1000 births) were recorded in the study. The prevalence of CH and non-NTD CH was higher in women in the no supplementation group than those in the FA supplementation group (0·92 and 0·72 v. 0·75 and 0·65 per 1000 births, respectively). FA supplementation during the periconceptional period significantly prevented CH (OR = 0·29, 95 % CI 0·12, 0·69) and non-NTD CH (OR = 0·34, 95 % CI 0·12, 0·97) in northern China, especially in a high-compliance group (≥ 80 %).Conclusions:Periconceptional FA supplementation did not significantly prevent CH overall in the current study. However, in the north of China with common maternal folate insufficiency, there was some evidence.

BACKGROUND Epidural analgesia is the most effective form of labour analgesia, but is associated with an increased risk of instrumental delivery. OBJECTIVE To evaluate factors that are associated with an increased risk of instrumental delivery. DESIGN Retrospective cohort data study. SETTING Singapore's major public maternity institution. PATIENTS All obstetric patients who received labour epidural analgesia for vaginal delivery between January 2012 to December 2015. INTERVENTION None. MAIN OUTCOME MEASURES Our primary outcome was the incidence of instrumental delivery. RESULTS Out of 17 227 pregnant women who received labour epidural analgesia, 12% (n = 2069) had instrumental delivery. Independent factors associated with an increased risk of instrumental delivery included maternal factors [nulliparity (adjusted odds ratio (aOR) 2.97, 95% CI 2.61 to 3.39, P

Background Gestational diabetes mellitus (GDM) is any degree of glucose intolerance with onset or first diagnosis in pregnancy. GDM has numerous potential complications and it is important to estimate its burden and risk factors. The objective of the meta-analysis was to determine the pooled prevalence of GDM in Nigeria and identify its determinants. Methods The study design was a meta-analysis; therefore the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Electronic databases (African Journal Online, PubMed, SCOPUS, and Google Scholar) and the gray literature were systematically searched. Statistical analysis was done with MetaXL using the random effect model. Heterogeneity was determined using the I2 statistic and the publication bias was checked with the Doi plot. Results The total sample size was 46 210. The prevalence of GDM in Nigeria was 0.5 - 38% and the pooled prevalence was 11.0% (95% CI 8-13). The I2 statistic was 99%. The Doi plot suggested some degree of bias. The most frequently reported determinants of GDM were previous macrosomic babies, maternal obesity, family history of diabetes, previous miscarriage, and advanced maternal age. Conclusion The prevalence of GDM in Nigeria is high and efforts should be geared at modifying its risk factors so as to reduce its prevalence and prevent the associated complications.

Objective To assess the positive predictive value (PPV) of noninvasive prenatal testing (NIPT) as a screening test for sex chromosome aneuploidy (SCA) with different maternal characteristics and prenatal decisions in positive cases. Materials and methods We retrospectively analysed 45,773 singleton pregnancies with different characteristics that were subjected to NIPT in the Maternity and Child Health Hospital of Anhui Province. The results were validated by karyotyping. Clinical data, diagnostic results, and data on pregnancy outcomes were collected. Results In total, 314 cases were SCA positive by NIPT; among those, 143 underwent invasive prenatal diagnostic testing, and 58 were true-positive. Overall, the PPVs for 45,X, 47,XXX, 47,XXY and 47,XYY were 12.5%, 51.72%, 66.67% and 83.33%, respectively. Interestingly, when only pregnant women of advanced maternal age (AMA) were screened, the PPVs for 45,X, 47,XXX, 47,XXY and 47,XYY were 23.81%, 53.33%, 78.95%, and 66.67%, respectively. The frequency of SCA was significantly higher in the AMA group than in the non-AMA group. The frequencies of 47,XXX and 47,XXY were significantly correlated with maternal age. Conclusion NIPT performed better in predicting sex chromosome trisomies than monosomy X, and patients with 45,X positive foetuses were more eager to terminate pregnancy than those with 47,XXX and 47,XYY. AMA may be a risk factor of having a foetus with SCA. Our findings may assist in genetic counselling of AMA pregnant women. Our pre- and posttest counselling are essential for familiarizing pregnant women with the benefits and limitations of NIPT, which may ease their anxiety and enable them to make informed choices for further diagnosis and pregnancy decisions.

In this review, we evaluate the different modalities of embryo genetic testing including preimplantation genetic testing for aneuploidy (PGT-A), for monogenic/single-gene abnormalities (PGT-M), and for chromosomal structural rearrangements (PGT-SR), with a clinical focus on indications, strengths, limitations, and testing parameters of each technique. Articles were obtained from PubMed and American College Obstetricians and Gynecologists and American Society Reproductive Medicine committee opinions. While some studies have suggested that PGT-A increases live births in women of advanced maternal age, a recent large randomized controlled trial has shown no benefit to PGT-A compared with morphology grading alone, including in the subgroup of women >35 years of age. Aneuploidy screening shortens the time to live birth in women with advanced maternal age. However, PGT-A is not without risk (false positive and false negative and “no read” results and embryonic damage), has significant financial cost, and should only be used in conjunction with genetic counseling and under the supervision of a qualified infertility subspecialist. PGT-A is most cost-effective among women ≥38 years of age. PGT-M and PGT-SR offer useful low-risk screening modalities for debilitating inherited disorders. Significant advances have been made in the ability to analyze human embryos for genetic abnormalities. Screening for monogenic and chromosomal structural abnormalities potentially eliminates disease transmission to subsequent generations. Optimization of these molecular techniques remains necessary to decrease the false positive rates. Additional study of embryo mosaicism is needed to clarify which embryos are appropriate for transfer.

To analyze the most frequent referrals for fetal echocardiography, including advanced maternal age and its association with abnormal results. We included all pregnant women referred to perform fetal echocardiography (gestational age 22-32 weeks) in 2 health centers in Rio de Janeiro, from June 2015 to June 2016. Advanced maternal age was considered when age was 35 years at the time of delivery). Referral reasons and results were recorded, according to the Brazilian Fetal Cardiology Statement. Crude and adjusted prevalence ratios were calculated (Poisson regression). We considered A total of 1,221 tests were analyzed. Abnormal fetal echocardiography was observed in 14.82% of the cases. The most frequent abnormalities were interventricular septal defect (6.39%), septal hypertrophy (3.35%) and atrioventricular septal defect (1.14%). Routine exams were performed in 559 women, 289 were referred for advanced maternal age and 373 were referred according to the Brazilian Fetal Cardiology Statement criteria. An obstetric ultrasound suggesting fetal cardiac abnormality, maternal diabetes, increased nuchal translucency, and obstetric ultrasound suggesting a noncardiac abnormality were strongly associated with an abnormal fetal echocardiography. Abnormal results were not more frequent in women with advanced maternal age when compared with the rest of the study group. It was observed that routine exams and advanced maternal age referrals were very frequent. Those exams were not associated to fetal echocardiography abnormalities. In this scenario, when the obstetric ultrasound suggests a fetal cardiac abnormality, the fetal echocardiography probably is abnormal. Therefore, obstetric ultrasound is a good screening method. Analisar as indicações mais frequentes para realização de ecocardiografia fetal, incluindo idade materna avançada, e a associação destas com exames alterados. MéTODOS: Foram incluídas todas as gestantes que realizaram ecocardiografia fetal na idade gestacional entre 22 e 32 semanas, em 2 centros de referência no Rio de Janeiro, no período de junho de 2015 a junho de 2016. Foi considerada idade materna avançada se no momento do parto a idade materna fosse 35 anos. As indicações e os resultados dos exames foram registrados, segundo a Diretriz Brasileira de Cardiologia Fetal. Foram calculadas as razões de prevalência brutas e ajustadas através da regressão de Poisson, considerando-se Um total de 1.221 exames foram analisados. A frequência de exame ecocardiográfico alterado foi 14,82%. As alterações mais frequentes foram defeito do septo interventricular (6,39%), hipertrofia septal (3,35%) e defeito do septo atrioventricular (1,14%). Quinhentos e cinquenta e nove exames foram realizados com indicação de rotina, 289 por idade materna avançada e 373 preenchiam critério de acordo com a Diretriz Brasileira de Cardiologia Fetal. O exame ecocardiográfico alterado foi associado ao ultrassom obstétrico sugerindo cardiopatia fetal, ao diabetes materno, à translucência nucal aumentada e ao ultrassom obstétrico sugerindo alteração extracardíaca. Não foi observada maior frequência de exame ecocardiográfico alterado nas gestantes com idade materna avançada, comparado ao restante da amostra. CONCLUSãO: Constatou-se elevada frequência de indicações de rotina, e por idade materna avançada isoladamente, que não foram associados a alterações da ecocardiografia fetal. Em nosso meio, quando o ultrassom obstétrico sugere cardiopatia fetal, é muito provável que a ecocardiografia fetal também seja anormal. Portanto, o ultrassom obstétrico é um bom método de rastreio pré-natal.

Objectives: To assess the association between advanced maternal age and adverse perinatal outcomes in single pregnancies. Materials and methods: A cohort study was conducted using data from 27,455 singleton births attended at our hospital between 2007 and 2018. Three maternal age groups were established, and perinatal outcomes were compared between-groups (40 years (n = 846; 3.1%). The data were compared using chi-square analysis and the results were adjusted using a logistic regression model. Decision trees were designed to examine the fetal mortality and caesarean section variables. We used the SPSS 23 statistical software program for the statistical analysis. Results: The mean age of the women was 31.21 years. No differences were found associated with age for neonatal acidosis, an Apgar score 35 years of age had worse perinatal outcomes, compared with younger women. This finding was more evident in patients >40 years of age, which highlighted the greater risk of fetal death and serious maternal complications in this group.

Objective We present prenatal diagnosis of familial 2p15 microduplication associated with pulmonary artery stenosis, single umbilical artery and left foot postaxial polydactyly on fetal ultrasound. Case report A 34-year-old woman underwent amniocentesis at 17 weeks of gestation because of advanced maternal age. Amniocentesis revealed the karyotype of 46,XX. Prenatal ultrasound examination at 21 weeks of gestation showed pulmonary artery stenosis, single umbilical artery and left foot postaxial polydactyly. Repeat amniocentesis was performed at 22 weeks of gestation and array comparative genomic hybridization (aCGH) analysis on the DNAs extracted from amniocytes revealed the result of arr 2p15 (61, 495, 220–62,885,679) × 3.0 [GRCh37 (hg19)] with a 1.391-Mb 2p15 duplication encompassing seven Online Mendelian Inheritance in Man (OMIM) genes of USP34, XPO1, FAM161A, CCT4, COMMD1, B3GNT2 and TMEM17. aCGH analysis on the DNAs extracted from parental bloods confirmed a familial transmission from a normal carrier mother who had no phenotypic abnormality. A 3270-g female baby was delivered at term with mild pulmonary artery stenosis and left foot postaxial polydactyly. The infant had normal physical and psychomotor development when follow-up at age of one year. Conclusion Prenatal diagnosis of fetal structural abnormalities should include aCGH analysis in addition to conventional cytogenetic analysis.

A delay in childbearing to later in life has increased the number of women of advanced maternal age (AMA) opting for assisted reproduction. Women should be made aware that there are age-related changes to fertility, including a decline in oocyte reserve and quality, in addition to an increase in the number of oocyte chromosomal aberrations. Success rates of assisted reproductive technology (ART) cycles decrease with advanced maternal age. There are different fertility options for women of AMA, including fertility preservation (oocyte or embryo freezing), in vitro fertilisation (IVF treatment) with or without preimplantation genetic screening and oocyte or embryo donation. Detailed counselling needs to be offered to these women with regard to the risks, success rates, ethical and legal implications of these fertility treatment options. Women of AMA should be screened for underlying medical conditions that could have an impact on maternal and neonatal morbidity and mortality.