Advanced maternaAdvanced maternall ageage & & pregnancy pregnancy

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Dr. Khattab KAEODr. Khattab KAEO

Prof. & Head of Obstetrics and Prof. & Head of Obstetrics and Gynaecology DepatmentGynaecology Depatment

Faculty of Medicine, Al-Azhar Faculty of Medicine, Al-Azhar University, University, DamiettaDamietta

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 Evaluation of ovarian reserve using a day 3 FSH and Eusing a day 3 FSH and E22 assay or clomiphene citrate assay or clomiphene citrate challenge (CCC) test is challenge (CCC) test is reasonable, but women reasonable, but women should not be falsely should not be falsely reassured that, if they have reassured that, if they have adequate testing, pregnancy adequate testing, pregnancy is guaranteed. is guaranteed.

Preeclampsia. Preeclampsia.

Disorders related to advanced age e.g. Disorders related to advanced age e.g. DM, obesity, thrombo-embolism & DM, obesity, thrombo-embolism & essential hypertension essential hypertension

The risk of preterm labour is 4-x The risk of preterm labour is 4-x higher. higher.

Also, there is a risk of postmaturity. Also, there is a risk of postmaturity.

Higher incidence of instrumental Higher incidence of instrumental delivery and CS; CPD is 5-x more delivery and CS; CPD is 5-x more common. 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 KhDr Kh

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

The elderly primigravida The elderly primigravida

This is a lady who is pregnant for the first This is a lady who is pregnant for the first time above the age of 35. time above the age of 35.

IncidenceIncidence is 1-2% and increasing due to is 1-2% and increasing due to social factors and the success of ART in social factors and the success of ART in treating relatively old infertile women i.e.treating relatively old infertile women i.e. there are 2 groups of elderly primigravida there are 2 groups of elderly primigravida

one who has married at a late age with no one who has married at a late age with no history of infertility, and history of infertility, and

one who has married at a usual age but got one who has married at a usual age but got pregnant after a period of infertility. pregnant after a period of infertility.

Dystocia dystrophia syndrome:Dystocia dystrophia syndrome:

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

ManagementManagementWomen should balance the biological Women should balance the biological

advantages of having a child at a advantages of having a child at a younger age against the economic younger age against the economic and social advantages of and social advantages of establishing a career. establishing a career.

Counsel on the age-related risk of Counsel on the age-related risk of fetal aneuploidy and offer prenatal fetal aneuploidy and offer prenatal screening and diagnosis. screening and diagnosis.

Weekly testing starting at 37 w would drop Weekly testing starting at 37 w would drop the risk of fetal death from 5.2 to 1.3%the risk of fetal death from 5.2 to 1.3%00..

The elderly primigravida should have a The elderly primigravida should have a hospital delivery with CEFM. hospital delivery with CEFM.

COCs are relatively contra-indicated in COCs are relatively contra-indicated in obese or smoker women over the age of obese or smoker women over the age of 35. 35.

ConclusionConclusion Age-related risk of infertility, include Age-related risk of infertility, include changes in uterine or hormonal fun-changes in uterine or hormonal fun-ction and oocyte quality. ction and oocyte quality.

Good ovarian reserve does not Good ovarian reserve does not guarantee pregnancy.guarantee pregnancy.

DM, obesity, TE, essential hypertension & DM, obesity, TE, essential hypertension & preeclampsia, preterm labour, post-preeclampsia, preterm labour, post-maturity,maturity, instrumental delivery & CS, instrumental delivery & CS, CPDCPD, s, soft tissue obstruction.oft tissue obstruction.

Chromosomal abnormalities, pregnancy Chromosomal abnormalities, pregnancy loss, ectopic pregnancy, IUGR,loss, ectopic pregnancy, IUGR, IUFD &IUFD & mmultiple pregnancy. ultiple pregnancy.

ConclusionConclusion 2 groups of elderly primigravida:one who 2 groups of elderly primigravida:one who

has married at a late age & one who has married at a late age & one who has a history of infertility/subfertility. has a history of infertility/subfertility.

Women should balance the biological Women should balance the biological advantages of having child at younger advantages of having child at younger age against establishing a career. age against establishing a career.

Offer prenatal screening and diagnosis. Offer prenatal screening and diagnosis.

Weekly testing from 37 w to drop the risk Weekly testing from 37 w to drop the risk of fetal death.of fetal death.

hospital delivery with CEFM. hospital delivery with CEFM.

COCs are relatively contraindicated in COCs are relatively contraindicated in obese or smoker. obese or smoker.

ThankThank you you