[The older primipara: labor induction and rigidity of the soft tissues]

Textbooks and literature reports frequently view the primipara of advanced age as a group being at increased risk of prolonged labor, dystocia, injuries to the birth canal and fetal distress. Particularly, a rigid cervix and reduced elasticity of the soft tissues of the birth canal are claimed responsible for these risks. Clinically, this view causes a higher frequency of operative deliveries in this group of primipara. The aim of the study was to evaluate the influence of a rigid cervix and/or reduced elasticity of the soft tissues in the birth canal on the course of labor. According to the definition of the FIGO we identified 201 primipara of advanced age as being more than 35 years old in our database. 5966 primipara (age 18-34) served as control. No significant difference was found in regard to Bishop score, progress of labor, vaginal and perineal lacerations, fetal distress and anaesthesia. However, the overall frequency of operative deliveries was increased from 27% to 58% in the primiparas of advanced age. In particular, the incidence of caesarean section increased from 11.5% to 39%. In 66% rigid tissues were called as one of the reasons for operative delivery in this group of aged primipara. However, our analysis of clinical variables does not support the notion that these women in general have an increased frequency of dystocia and/or a more rigid cervix and decreased elasticity of the birth canal. We feel that in a considerable number of patients, the concern of the obstetricians and the women in a safer and less painful delivery by caesarean section are reasons for these increased operative procedures at the end of the reproductive period.