Advanced maternal age as a risk factor for cesarean delivery

Article Abstract:

The number of cesarean section deliveries has gradually increased in the United States, and this method now accounts for a quarter of all deliveries. The frequency is even higher for women over 35 who are having their first baby. Many have questioned the need for cesarean deliveries when there are no medical indications that the infant would be at high risk from a normal delivery. In addition, no studies have shown conclusively that the mother's age is such a risk. This study examined whether maternal age was a factor contributing to decisions for delivering by cesarean section. The medical records for all live births in Washington state for 1986 and 1987 were obtained. Analysis was limited to records for a particular county, excluding those for women who had previous cesarean deliveries and for whom complete birth records were unavailable. Records of a total of 2,985 women between the ages of 35 and 50 were examined and compared with those of a random sampling from 6,140 women between the ages of 20 and 29. Most of the women were white in both age groups, with the older women having a higher socioeconomic status and delivering infants with generally higher birth weights. Cesarean rates were highest for the older women having their first child (33 percent) compared with 24 percent for the younger women having a first child, 9.9 percent for older women who had previously given birth, and 6.4 percent for younger women who had previously given birth. When factors other than age were excluded, the cesarean rate was more than twice as high for the older women having their first child than for the younger women having their first child (14.3 versus 6 percent). These results indicate that cesarean sections are performed more frequently on older women merely because of their increased age. This procedure increases the risk to the mother and adds to medical costs. Obstetricians need to be aware that age alone is not a reason to perform a cesarean. (Consumer Summary produced by Reliance Medical Information, Inc.)

Middle age, Evaluation, Complications and side effects, Demographic aspects, Delivery (Childbirth), Cesarean section, Maternal age, Childbirth in middle age

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Pre-induction cervical ripening with prostaglandin E2 gel: intracervical versus intravaginal route

Article Abstract:

For many different reasons, it may be desirable to induce labor, usually by rupturing the fetal membranes and/or administering medication that promotes uterine contractions. Unless the cervix is soft, or ripe, induction may be difficult to achieve. The cervix undergoes critical changes between 12 hours and 8 weeks before the onset of labor. This ripening is regulated by hormones such as prostaglandin (PG) E2, one of a group of hormones that is produced locally and acts locally. The success of labor induction is reliant upon the extent of cervical ripening, and the topical application of PGE2 gel has been used to induce this ripening. However, the effectiveness of varied dosages and methods of application has not been established. Consequently, variations in PGE2 application and dosage were assessed in 100 obstetric patients. Fifty-two women were treated with 0.5 milligrams (mg) of PGE2 applied at the level of the cervix, while 48 women were given 3 mg of PGE2 intravaginally. Significantly more women went into labor after intravaginal administration. Among the women who did not go into labor soon after treatment, cervical ripening was significantly more advanced among those treated intravaginally. More side effects, such as hypertonus (increased muscular tension), fever, nausea, and diarrhea were observed in intravaginally treated women, but they were generally mild or resolved quickly. Multiple treatments were needed more often in the intracervically treated group. These findings suggest that intravaginal application of PGE2 gel is easier and more effective than intracervical treatment in enhancing cervical ripening and the onset of labor. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Dosage and administration, Labor (Obstetrics), Cervix uteri, Labor, Induced (Obstetrics), Induced labor, Synthetic prostaglandins E

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