Module 7 - IOL and Advance Maternal Age

Question 1

Define advance maternal age.

Answer 1

> 40 years.

Question 2

What risks are increased with advanced maternal age?

Answer 2

Maternal risks:
-more likely to have co-morbidity.
-GDM
-PET
-PPH

Foetal risks:
-PTL (and post maturity)
-Placental previa
-Placental abruption
-IUGR/low birth rate
-Stillbirth
- Malpresentation.

(assisted fertility is a confounder).

Question 3

What is the incidence of stillbirth at 39/40 in women under 35 years compared to women over 40 years?

Answer 3

<35 years : 1/1,000

> 40 years : 2/1,000

Question 4

What is the rational for IOL at 39/40 in women over 40 years?

Answer 4

Incidence of stillbirth is 2/1,000 which is the same in young mothers at 41/40. Therefore IOL should be offered.

Question 5

In older mothers, does the presence of IUGR increase their risk of stillbirth?

Answer 5

No,
the risk of stillbirth is the same in IUGR babies regardless of mum’s age.

Question 6

If older mums are induced, is NVD or EmLSCS more likely?

Answer 6

NVD is more likely (i.e. so do not have to section every women purely for advance maternal age!).