Obstetrical management of the older gravida

In developed countries, an increase in the average age of the gravida has been documented. The mean age of primiparous women in Austria rose from 25 years in 1991 to 28 years in 2008. In Germany in 2006, most gravidas were between the ages of 30 and 34 years whereas in the 1970s, most babies were born to women aged 20-24 years. Delayed childbearing and increased maternal age are associated with increased obstetrical and perinatal complications and, therefore, require adjustments in obstetrical management. Increasing maternal age is associated with pre-existing maternal risk factors such as diabetes mellitus, hypertension, myomas or obesity. In addition to lower fecundability and higher rates of chromosomal aberrations, higher rates of spontaneous early abortion are also common complications in early pregnancy among older women. In ongoing pregnancies, complications such as gestational diabetes, hypertensive disorders and low birth weight are associated with increasing maternal age. Furthermore, gravidas of advanced age are at a higher risk for stillbirth and perinatal morbidity and mortality. At delivery, increased maternal age is associated with an increased rate of malpresentation and represents an independent odds ratio for cesarean section. Owing to these facts, obstetric management in the older gravida needs to be adapted in order to manage the possible complications.