Obstetric outcome of elderly low-risk nulliparae

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Midwifery Care

Background:

• Advanced maternal age (35 years and older) is associated with potential obstetric complications.
• Nulliparous women, particularly older ones, require careful monitoring during pregnancy and labor.
• Midwifery-led care models aim to provide personalized and evidence-based support for diverse maternal populations.

Purpose of the Study:

• To compare pregnancy and labor referrals, delivery modes, and obstetric outcomes for first-time mothers aged 35+ versus those aged 20-30.
• To evaluate the safety and effectiveness of midwifery care for older nulliparous women.
• To identify potential disparities in obstetric management and outcomes between maternal age groups.

Main Methods:

• Prospective cohort study involving 146 nulliparous women aged 35+ and 306 nulliparous women aged 20-30.
• Data collected from seven independent midwife practices in Amsterdam.
• Comparison of referral rates, mode of delivery, and obstetric outcomes between the two age groups.

Main Results:

• No significant differences in referral rates during pregnancy were observed between the elderly and younger nulliparae.
• Obstetric outcomes remained comparable between groups after appropriate pregnancy selection.
• A higher incidence of episiotomies was noted in the elderly nulliparous group compared to the younger group.

Conclusions:

• Elderly nulliparous women receiving midwife care do not face an elevated risk of fetal distress or other emergencies when properly selected during pregnancy.
• High referral rates during labor were a common finding for both younger and older nulliparous women in this cohort.
• Midwifery care appears to ensure favorable obstetric outcomes for nulliparous women of advanced maternal age, with careful selection being key.