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Labor outcome at extremely advanced maternal age.

Sarah S Osmundson1, Jeffrey B Gould2, Alexander J Butwick3

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Women aged 50 and over delivering singleton babies have higher cesarean rates but most achieve vaginal birth after a trial of labor. Neither trial of labor nor prelabor cesarean delivery significantly impacts maternal or neonatal morbidity.

Keywords:
advanced maternal agecesarean deliveryextreme advanced maternal agetrial of labor

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Area of Science:

  • Reproductive Health
  • Maternal-Fetal Medicine
  • Obstetrics and Gynecology

Background:

  • Advanced maternal age (AMA) is associated with increased cesarean delivery risk.
  • The influence of parity and trial of labor on this association in AMA women requires clarification.

Purpose of the Study:

  • To investigate delivery modes and maternal outcomes in AMA women.
  • To stratify analyses by parity and trial of labor status.

Main Methods:

  • Retrospective cohort study of singleton births in California (2007-2011).
  • Data linkage of maternal discharge and birth certificate records.
  • Comparison of non-AMA (20-34 years) and AMA (≥35 years) women, stratified by age groups and parity.

Main Results:

  • Cesarean delivery rates increased significantly with maternal age, reaching 62.4% for women ≥50 years.
  • Nulliparous women ≥50 years were less likely to attempt trial of labor but more likely to have intrapartum cesarean delivery.
  • Despite higher cesarean rates, women ≥50 years experienced significantly higher severe maternal morbidity and neonatal ICU admissions, not linked to trial of labor or cesarean route.

Conclusions:

  • Women aged ≥50 years have higher cesarean delivery rates but most achieve vaginal birth following a trial of labor.
  • Trial of labor or prelabor cesarean delivery showed no significant association with maternal or neonatal morbidity.
  • Both approaches (trial of labor or elective cesarean) may be considered for extremely AMA women.