| Objective:(1)To compare the difference in advanced maternal age of pregnancy complications,mode of delivery and perinatal outcomes with younger parturient;(2)To discuss the relationship between pregnant women age increase and the occurrence of adverse pregnancy outcomes;(3)To strengthen the advanced maternal age during pregnancy and labor management,and to provide reference opinions for reducing maternal and infant adverse outcomes;(4)To provide guidance for advanced maternal age the way of delivery.Methods: As the study group,406 cases of advanced maternal age who were over 35 years old and from Yi Ji Shan Hospital Department of Obstetrics delivery from June2014 to December 2015 were collected,which elderly primipara of group 1,elderly multipara as study group 2.1800 cases of maternal age were selected hospitalized childbirth(20-34 years old)as the control group,the school-age primipara as control group,age of multipara and 2 in the control group.Younger group case selection principle: according to the admission time in order to take a month before the 100 cases of delivery,which miscarriage,pregnancy early metaphase induced labor,abortion is not included in,insufficient samples according to the time sequence to selected cases,until the full 100 cases,a total of 18 months,cases of 1800 cases.Take control study method,a retrospective analysis of the clinical data of each group of pregnant women,and to compare the different in maternal pregnancy complications,mode of delivery,cesarean section indications,perinatal outcomes,childbirth and puerperium complications.Results:1.Complications of pregnancy:(1)HDCP: the incidence rate of advanced maternal age group was higher than younger parturient group(P < 0.01);the primipara and multipara of elderly group were higher than younger group(P < 0.05);the primipara was higher than multipara of elderly group(P < 0.01).(2)GDM: advanced maternal age group had higher incidence rate than younger parturient group(P < 0.01);the primipara and multipara of elderly group were higher than younger group(P < 0.05);the primipara compare with the multipara of elderly group the difference no statistical significance(P > 0.05).(3)PROM: the incidence rate of elderly multipara group was higher than younger multipara group(P < 0.05),and compared with the elderly primipara group was no statistical difference(P > 0.05).(4)PP: the advanced maternal age group had higher incidence rate than younger parturient group(P < 0.01);elderly multipara group was higher than younger multipara group(P < 0.05);the primipara was lower than multipara of elderly group(P < 0.05);.(5)Uterine fibroids: advanced maternal age group was higher than younger parturient group(P < 0.01);elderly primipara group was lower than elderly multipara group(P <0.05);the primipara and multipara of elderly group were higher than younger group(P< 0.05).(6)Heart disease: advanced maternal age group was higher than younger parturient group(P < 0.05);the elderly group was higer than younger group of multipara(P <0.05);elder primipara group compared with elderly multipara was no statistical difference(P > 0.05).2.Perinatal outcomes:(1)Neonatal birth weight,1 minute Apgar score: advanced maternal age group was lower than younger parturient group(P < 0.05).(2)Fetal growth restriction(FGR),preterm neontes,asphyxia of newborn: advanced maternal age group was higher than younger parturient group(P < 0.01).(3)Macrosomia: no statistical difference between advanced maternal age group and younger parturient group(P > 0.05),while the elderly multipara group was higher than that of elderly primipara group(P < 0.05).3.Delivery mode:(1)Cesarean section rate: the primipara and multipara of elderly group were higher than younger group(P < 0.01);elderly multipara group compared with elderly primipara was no statistical difference(P > 0.05).(2)Vaginal delivery rate: the primipara and multipara of elderly group were lower than younger group(P < 0.01);elderly multipara group compared with elderly primipara was no statistical difference(P > 0.05).(3)The rate of vaginal delivery failure and transfer to cesarean section: the three groups were showed no statistical difference(P > 0.05).4.The mode of delivery and LDT relationship:(1)The rate of cesarean section: LDT is more than or equal to 10 years group was significantly higher than that of equal to or less than 5 years group,showed a statistically significant difference(P < 0.01);the other comparison had no statistical significance(P > 0.05).(2)The rate of vaginal delivery: LDT is equal to or more than 10 years was lower than less than or equal to 5 years group and 5-10 years group(P < 0.01);compare between less than or equal to 5 years group and 5-10 years group was no statistical difference(P > 0.05).(3)The rate of vaginal delivery failure and transfer to cesarean section: LDT is equal to or more than 10 years was higer than less than or equal to 5 years group and 5-10 years group(P < 0.01);compare between less than or equal to 5 years group and 5-10 years group was no statistical difference(P > 0.05).5 Indications of cesarean section:(1)Elderly primipara group ranked the top four cesarean section indications according to the order: social factors,pregnancy complications,abnormal fetal position,fetal distress.(2)Elderly multipara group ranked the top four cesarean section indications according to the order: scarred uterus,pregnancy complications,social factors,fetal distress.(3)Younger primipara ranked the top four cesarean section indications according to the order: social factors,pregnancy complications,abnormal fetal position,fetal distress.(4)Younger multipara group ranked the top four cesarean section indications according to the order: scarred uterus,social factors,pregnancy complications,abnormal fetal position.Conclusions:1.Advanced maternal age occurred in gestational diabetes mellitus(GDM),hypertensive disorders complicating pregnancy(HDCP),placenta previa(PP),and pregnancy complicated with uterine fibroids and heart disease were higher than younger parturient;the incidence rate of FGR,premature infants and neonates of asphyxia were higher in advanced maternal age,and elderly multipara had high probability to born macrosomia.2.The cesarean section rate of advanced maternal age was higher,in which the elderly primipara major cesarean section indications were social factors,while the elderly multipara was scarred uterus.For the elderly primipara,if there have the possibility of success of vaginal delivery,it should be encouraged to vaginal delivery.The elderly multipara with scar uterus if have vaginal delivery indication is also suitable for vaginal delivery.3.The elderly primipara pregnancy increases the risk of mother and fetal,the cesarean section rate increased significantly.Therefore,it should be reduced elderly primipara proportion,advocate of child-bearing age.4.The pregnancy and the last delivery time intervals over 10 years old multipara,for the vaginal delivery failure and transfer to cesarean section with high probability,so choose childbirth way need to be careful,should be a reasonable evaluation of vaginal delivery conditions,do not blindly trial-produce. |
