Advanced maternal age & pregnancy By Dr. Khattab KAEO Prof. & Head of Obstetrics and Gynaecology Depatment Faculty of Medicine, Al-Azhar University, Damietta

Effect on pregnancy: Maternal: The most significant hurdle for older women is their age-related risk of infertility, including changes in uterine or hormonal function and oocyte quality.

Evaluation of ovarian reserve using a day 3 FSH and E 2 assay or clomiphene citrate challenge (CCC) test is reasonable, but women should not be falsely reassured that, if they have adequate testing, pregnancy is guaranteed.

Preeclampsia. Preeclampsia. Disorders related to advanced age e.g. DM, obesity, thrombo- embolism & essential hypertension The risk of preterm labour is 4-x higher. The risk of preterm labour is 4-x higher. Also, there is a risk of postmaturity. Also, there is a risk of postmaturity. Higher incidence of instrumental delivery and CS; CPD is 5-x more common. Higher incidence of instrumental delivery and CS; CPD is 5-x more common. Soft tissue obstruction eg by fibroid Soft tissue obstruction eg by fibroid

Fetal: Chromosomal abnormalities; the risk of Down syndrome is 1:365 at the age of 35. Increased incidence of pregnancy loss. Increased incidence of ectopic pregnancy. IUGR. Due to a higher IUFD. incidence of preeclampsia. Multiple pregnancy (DZ twins).

Dr Kh

Effect of pregnancy: Pregnancy may cause red degeneration or torsion of an already present fibroid.

The elderly primigravida This is a lady who is pregnant for the first time above the age of 35. Incidence is 1-2% and increasing due to social factors and the success of ART in treating relatively old infertile women i.e. there are 2 groups of elderly primigravida one who has married at a late age with no history of infertility, and one who has married at a usual age but got pregnant after a period of infertility.

Dystocia dystrophia syndrome: Short, plum patient with an android pelvis, history of infertility, recurrent abortion and obstructed labour. Dystocia dystrophia syndrome: Short, plum patient with an android pelvis, history of infertility, recurrent abortion and obstructed labour.

Management Women should balance the biological advantages of having a child at a younger age against the economic and social advantages of establishing a career. Counsel on the age-related risk of fetal aneuploidy and offer prenatal screening and diagnosis.

Weekly testing starting at 37 w would drop the risk of fetal death from 5.2 to 1.3% 0. The elderly primigravida should have a hospital delivery with CEFM. COCs are relatively contra-indicated in obese or smoker women over the age of 35.

Conclusion Age-related risk of infertility, include changes in uterine or hormonal fun- ction and oocyte quality. Good ovarian reserve does not guarantee pregnancy. DM, obesity, TE, essential hypertension & preeclampsia, preterm labour, post- maturity, instrumental delivery & CS, CPD, soft tissue obstruction. Chromosomal abnormalities, pregnancy loss, ectopic pregnancy, IUGR, IUFD & m ultiple pregnancy.

Conclusion 2 groups of elderly primigravida:one who has married at a late age & one who has a history of infertility/subfertility. Women should balance the biological advantages of having child at younger age against establishing a career. Offer prenatal screening and diagnosis. Weekly testing from 37 w to drop the risk of fetal death. hospital delivery with CEFM. COCs are relatively contraindicated in obese or smoker.

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