Unplanned cesarean sections in advanced maternal age: A predictive model

Area of Science:

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

Background:

• Global rise in maternal age necessitates identification of prognostic factors for older women.
• Advanced maternal age (40+) is associated with increased obstetric risks.
• Need for predictive tools to manage pregnancies in women aged 40 years and older.

Purpose of the Study:

• To identify prognostic factors for maternal and perinatal outcomes in women aged 40 years and older.
• To develop a predictive model for unplanned cesarean sections in advanced maternal age pregnancies.
• To compare outcomes between women aged 40-44 and those 45+ years.

Main Methods:

• Retrospective cohort study of 1660 women aged 40+ years (2016-2019).
• Comparison of outcomes between advanced maternal age (40-44) and very advanced maternal age (45+).
• Multivariate regression analysis to identify predictors of unplanned cesarean sections; model construction.

Main Results:

• Unplanned cesarean sections occurred in 21.1% (40-44) and 29.1% (45+) of deliveries.
• Predictive factors for unplanned cesarean section included higher BMI, no prior vaginal delivery, and longer cervical priming duration.
• A predictive model achieved an AUC of 0.75; spontaneous labor onset was protective.

Conclusions:

• Women of advanced and very advanced maternal age face a higher likelihood of unplanned cesarean sections.
• A validated predictive model can forecast unplanned cesarean sections in this population.
• Key risk factors include BMI, prior delivery history, and cervical priming; spontaneous labor is protective.