Unplanned cesarean sections in advanced maternal age: A predictive model
Abstract Introduction As maternal age during pregnancy is rising all over the world, there is a growing need for prognostic factors that determine maternal and perinatal outcomes in older women. Material and methods This study is a retrospective cohort study of women aged 40 years or older at the ti...
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| Format: | Article |
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Wiley
2024-05-01
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| Series: | Acta Obstetricia et Gynecologica Scandinavica |
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| Online Access: | https://doi.org/10.1111/aogs.14765 |
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| author | Joyce Veenstra Zoë Cohen Fleurisca J. Korteweg David P. van derHam Simone M. Kuppens Janna A. Kroese Brenda B. Hermsen Marije M. Kamphuis Joost W. Vanhommerig Maria G. vanPampus |
| author_facet | Joyce Veenstra Zoë Cohen Fleurisca J. Korteweg David P. van derHam Simone M. Kuppens Janna A. Kroese Brenda B. Hermsen Marije M. Kamphuis Joost W. Vanhommerig Maria G. vanPampus |
| author_sort | Joyce Veenstra |
| collection | DOAJ |
| description | Abstract Introduction As maternal age during pregnancy is rising all over the world, there is a growing need for prognostic factors that determine maternal and perinatal outcomes in older women. Material and methods This study is a retrospective cohort study of women aged 40 years or older at the time of delivery in four Santeon hospitals across the Netherlands between January 2016 and December 2019. Outcomes were compared between women of 40–44 years (advanced maternal age) and 45 years and older (very advanced maternal age). Primary outcome was unplanned cesarean section, secondary outcomes included postpartum hemorrhage and neonatal outcomes. Multivariate regression analysis was performed to analyze predictive factors for unplanned cesarean sections in women who attempted vaginal delivery. Subsequently, a predictive model and risk scores were constructed to predict unplanned cesarean section. Results A cohort of 1660 women was analyzed; mean maternal age was 41.4 years, 4.8% of the women were 45 years and older. In both groups, more than half of the women had not delivered vaginally before. Unplanned cesarean sections were performed in 21.1% of the deliveries in advanced maternal age and in 29.1% in very advanced maternal age. Four predictive factors were significantly correlated with unplanned cesarean sections: higher body mass index (BMI), no previous vaginal delivery, spontaneous start of delivery and number of days needed for cervical priming. A predictive model was constructed from these factors with an area under the curve of 0.75 (95% confidence interval 0.72–0.78). A sensitivity analysis in nulliparous women proved that BMI, days of cervical priming, age, and gestational age were risk factors, whereas spontaneous start of delivery and induction were protective factors. There was one occurrence of neonatal death. Conclusions Women of advanced maternal age and those of very advanced maternal age have a higher chance of having an unplanned cesarean section compared to the general obstetric population in the Netherlands. Unplanned cesarean sections can be predicted through use of our predictive model. Risk increases with higher BMI, no previous vaginal delivery, and increasing number of days needed for cervical priming, whereas spontaneous start of labor lowers the risk. In nulliparous women, age and gestational age also increase risk, but induction lowers the risk of having an unplanned cesarean section. |
| format | Article |
| id | doaj-art-a096f73d136e43d594a5f13c2b1bf767 |
| institution | DOAJ |
| issn | 0001-6349 1600-0412 |
| language | English |
| publishDate | 2024-05-01 |
| publisher | Wiley |
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| series | Acta Obstetricia et Gynecologica Scandinavica |
| spelling | doaj-art-a096f73d136e43d594a5f13c2b1bf7672025-08-20T03:22:16ZengWileyActa Obstetricia et Gynecologica Scandinavica0001-63491600-04122024-05-01103592793710.1111/aogs.14765Unplanned cesarean sections in advanced maternal age: A predictive modelJoyce Veenstra0Zoë Cohen1Fleurisca J. Korteweg2David P. van derHam3Simone M. Kuppens4Janna A. Kroese5Brenda B. Hermsen6Marije M. Kamphuis7Joost W. Vanhommerig8Maria G. vanPampus9Department of Obstetrics and Gynecology Flevoziekenhuis Almere the NetherlandsEmergency Department Dijklander Ziekenhuis Purmerend and Hoorn the NetherlandsDepartment of Obstetrics and Gynecology Martini Hospital Groningen the NetherlandsDepartment of Obstetrics and Gynecology Martini Hospital Groningen the NetherlandsDepartment of Obstetrics and Gynecology Catharina Hospital Eindhoven the NetherlandsDepartment of Obstetrics and Gynecology Medisch Spectrum Twente Enschede the NetherlandsDepartment of Obstetrics and Gynecology OLVG Amsterdam the NetherlandsDepartment of Obstetrics and Gynecology OLVG Amsterdam the NetherlandsDepartment of Research and Epidemiology OLVG Amsterdam the NetherlandsDepartment of Obstetrics and Gynecology OLVG Amsterdam the NetherlandsAbstract Introduction As maternal age during pregnancy is rising all over the world, there is a growing need for prognostic factors that determine maternal and perinatal outcomes in older women. Material and methods This study is a retrospective cohort study of women aged 40 years or older at the time of delivery in four Santeon hospitals across the Netherlands between January 2016 and December 2019. Outcomes were compared between women of 40–44 years (advanced maternal age) and 45 years and older (very advanced maternal age). Primary outcome was unplanned cesarean section, secondary outcomes included postpartum hemorrhage and neonatal outcomes. Multivariate regression analysis was performed to analyze predictive factors for unplanned cesarean sections in women who attempted vaginal delivery. Subsequently, a predictive model and risk scores were constructed to predict unplanned cesarean section. Results A cohort of 1660 women was analyzed; mean maternal age was 41.4 years, 4.8% of the women were 45 years and older. In both groups, more than half of the women had not delivered vaginally before. Unplanned cesarean sections were performed in 21.1% of the deliveries in advanced maternal age and in 29.1% in very advanced maternal age. Four predictive factors were significantly correlated with unplanned cesarean sections: higher body mass index (BMI), no previous vaginal delivery, spontaneous start of delivery and number of days needed for cervical priming. A predictive model was constructed from these factors with an area under the curve of 0.75 (95% confidence interval 0.72–0.78). A sensitivity analysis in nulliparous women proved that BMI, days of cervical priming, age, and gestational age were risk factors, whereas spontaneous start of delivery and induction were protective factors. There was one occurrence of neonatal death. Conclusions Women of advanced maternal age and those of very advanced maternal age have a higher chance of having an unplanned cesarean section compared to the general obstetric population in the Netherlands. Unplanned cesarean sections can be predicted through use of our predictive model. Risk increases with higher BMI, no previous vaginal delivery, and increasing number of days needed for cervical priming, whereas spontaneous start of labor lowers the risk. In nulliparous women, age and gestational age also increase risk, but induction lowers the risk of having an unplanned cesarean section.https://doi.org/10.1111/aogs.14765advanced maternal agematernal outcomeunplanned cesarean sectionvery advanced maternal age |
| spellingShingle | Joyce Veenstra Zoë Cohen Fleurisca J. Korteweg David P. van derHam Simone M. Kuppens Janna A. Kroese Brenda B. Hermsen Marije M. Kamphuis Joost W. Vanhommerig Maria G. vanPampus Unplanned cesarean sections in advanced maternal age: A predictive model Acta Obstetricia et Gynecologica Scandinavica advanced maternal age maternal outcome unplanned cesarean section very advanced maternal age |
| title | Unplanned cesarean sections in advanced maternal age: A predictive model |
| title_full | Unplanned cesarean sections in advanced maternal age: A predictive model |
| title_fullStr | Unplanned cesarean sections in advanced maternal age: A predictive model |
| title_full_unstemmed | Unplanned cesarean sections in advanced maternal age: A predictive model |
| title_short | Unplanned cesarean sections in advanced maternal age: A predictive model |
| title_sort | unplanned cesarean sections in advanced maternal age a predictive model |
| topic | advanced maternal age maternal outcome unplanned cesarean section very advanced maternal age |
| url | https://doi.org/10.1111/aogs.14765 |
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