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Pregnancy over age 35
Pregnancy Over Age 35 Kirz D, Dorchester W, Freeman R: Advanced maternal age: The mature gravida. AM J OBSTET GYNECOL 152: 7, 1985. Pregnancies in women of advanced maternal age often are considered high risk-despite the lack of recent research on this topic. This study sought to analyze pregnancy outcomes for a group of women age 35 and older to determine what, if any, their risks might be. The study group consisted of all women delivered over a 3-year period. There were 1023 women over age 35 (7.1%) whose outcomes were compared with those of 5343 women age 20 to 25 who delivered during the same period. Pregnancy complications, labor complications, delivery outcomes, and neonatal outcomes were compared. There was a statistically significant increase in diabetes and hypertension and a lower incidence of premature labor among the older women, the former reflecting the effects of aging. This study did not show an increase in prolonged labor as has been suggested by other authors. There was no increase in stillbirth or neonatal death rates for neonates of older women, however, there was a definite increase in macrosomic babies for the older parous women. The authors suggest that the increase they found in operative deliveries among the older women reflects both the high frequency of epidural anesthesia used at their institution and obstetricians’ perceptions of the high-risk nature of the older woman’s pregnancy. The authors conclude: “When they are given good prenatal and intrapartum care and when signs of diabetes and hypertension are monitored, the risks to
Journal of Nurse-Midwifery Copyright
c:
1985by
the American
??
healthy women 35 years and older in the 1980s may be no more than the risks to the younger parturients.” They suggest dropping the pejorative and offensive terms often applied to the woman over 35 years, and replacing elderly or senescent with mature-the mature gravida.
Use of Midforceps Dierker L, Rosen M, Thompson K, et
al: The midforceps:
This study documents maternal and infant outcomes among 176 midforceps deliveries (0.8% of all deliveries) that occurred over a 6-year period. The study population of midforceps deliveries was compared with similar groups matched by gestational age, birth weight, labor abnormality, and fetal heart rate abnormality who were delivered by low forceps, cesarean section, or spontaneously. The increased proportion of nulliparous women (80%) in the midforceps groups was highly significant, whereas infants of excessive size were no more common among the midforceps patients. Increased use of oxytocin and increased use of epidural analgesia were highly associated with midforceps use, as were several factors indicative of fetal distress. Increased maternal morbidity was evident in the increase in third-degree perineal lacerations and in blood loss estimated to be more than 500 mL. An increase in short-term neonatal morbidity was evidenced by more frequent low lminute Apgar scores and more cephalohematomas among infants delivered by midforceps. However, shoulder dystocia, seventh nerve palsies, brachial paralysis,
Vol. 30, No. 6, November/December
College
Maternal and
n'2Onatd OUtCOmeS. AMJ OBSTETGYNECOL 152: 176, 1985.
of Nurse-Midwives
neonatal seizures, and central nervous system hemorrhage were not significantly different in the various groups, even when midforceps cases performed primanly for dystocia or fetal distress were compared with matched cesarean section cases. The authors note an association of midforceps with epidural use. They conclude that because most differences among the midforceps, low forceps, and cesarean groups were not significant, it may be that the conditions leading to the midforceps operation reflect the increased risk rather than the delivery technique itself. The authors do not advocate more liberal use of midforceps, they simply state that judicious use of midforceps has not been associated with an increase in shortterm risk, and they suggest further longterm, follow-up studies.
Chorionic
Villus Sampling
Elias S, Simpson J, Martin A, et al: Chorionic villus sampling for firsttrimester prenatal diagnosis: Northwestern University program. AM J OBSTET GYNECOL
152:204,
1985.
This report presents early results with attempts to develop a chorionic villus sampling program. Initially the authors attempted to sample villi in 58 patients before elective first-trimester abortion (at 6 to 12 weeks’ gestation). In 50 cases acceptable specimens were obtained with one or two attempts. It also was clear that better quality specimens were obtained more frequently with increasing physician experience. Both direct methods and cell cultures were used to evaluate samples. The direct method will yield results in 24
349
1985 0091.2182/85!$03.30
Journal of Nurse-Midwifery Copyright
c:
1985by
the American
??
healthy women 35 years and older in the 1980s may be no more than the risks to the younger parturients.” They suggest dropping the pejorative and offensive terms often applied to the woman over 35 years, and replacing elderly or senescent with mature-the mature gravida.
Use of Midforceps Dierker L, Rosen M, Thompson K, et
al: The midforceps:
This study documents maternal and infant outcomes among 176 midforceps deliveries (0.8% of all deliveries) that occurred over a 6-year period. The study population of midforceps deliveries was compared with similar groups matched by gestational age, birth weight, labor abnormality, and fetal heart rate abnormality who were delivered by low forceps, cesarean section, or spontaneously. The increased proportion of nulliparous women (80%) in the midforceps groups was highly significant, whereas infants of excessive size were no more common among the midforceps patients. Increased use of oxytocin and increased use of epidural analgesia were highly associated with midforceps use, as were several factors indicative of fetal distress. Increased maternal morbidity was evident in the increase in third-degree perineal lacerations and in blood loss estimated to be more than 500 mL. An increase in short-term neonatal morbidity was evidenced by more frequent low lminute Apgar scores and more cephalohematomas among infants delivered by midforceps. However, shoulder dystocia, seventh nerve palsies, brachial paralysis,
Vol. 30, No. 6, November/December
College
Maternal and
n'2Onatd OUtCOmeS. AMJ OBSTETGYNECOL 152: 176, 1985.
of Nurse-Midwives
neonatal seizures, and central nervous system hemorrhage were not significantly different in the various groups, even when midforceps cases performed primanly for dystocia or fetal distress were compared with matched cesarean section cases. The authors note an association of midforceps with epidural use. They conclude that because most differences among the midforceps, low forceps, and cesarean groups were not significant, it may be that the conditions leading to the midforceps operation reflect the increased risk rather than the delivery technique itself. The authors do not advocate more liberal use of midforceps, they simply state that judicious use of midforceps has not been associated with an increase in shortterm risk, and they suggest further longterm, follow-up studies.
Chorionic
Villus Sampling
Elias S, Simpson J, Martin A, et al: Chorionic villus sampling for firsttrimester prenatal diagnosis: Northwestern University program. AM J OBSTET GYNECOL
152:204,
1985.
This report presents early results with attempts to develop a chorionic villus sampling program. Initially the authors attempted to sample villi in 58 patients before elective first-trimester abortion (at 6 to 12 weeks’ gestation). In 50 cases acceptable specimens were obtained with one or two attempts. It also was clear that better quality specimens were obtained more frequently with increasing physician experience. Both direct methods and cell cultures were used to evaluate samples. The direct method will yield results in 24
349
1985 0091.2182/85!$03.30