Predicting vaginal delivery in pregnant women of 45 years and older

Vaginal delivery (VD) can be successfully and safely achieved in women with very and extremely advanced age. We aim to assess obstetric and perinatal outcomes in a large cohort of women aged > 45 and to develop a statistical model predicting VD.

This is a retrospective analysis of prospectively collected data on singleton pregnant women aged > 45 years, with intended VD, at five Italian academic maternity centers between 2016 and 2022. Women with delivery < 22 weeks, and undergoing pre-labor CS, were excluded. The primary outcome was VD. Secondary outcomes included: induction and failed induction of labor; CS for failure to progress or cervical dystocia. The predictive model for VD was built by means of a multivariable logistic regression.

During the study period, 625 women were managed at the participating centers, and 293 were included in the analysis. VD occurred in 75.8% of cases, ranging between 67.1% and 86.4% among nulliparous and multiparous women, respectively. Induction of labor (IOL) was performed in 173 women (59%). Among the 71 (24.2%) patients undergoing CS, 25 (35.2%) had a failed induction whereas the remaining 46 (64.8%) had an urgent CS in labor. Among the 222 women with VD, vacuum occurred in 39 (17.6%). The predictive model allows to calculate the probability of VD according to five significant variables: maternal age, pregestational BMI, height, parity, and whether labor was induced or not.

The predictive model we developed may help clinicians in counselling women to choose their best childbirth.