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Delivery outcome after trial of labor in nulliparous women 40 years or older - a nationwide population-based study.

Journal article
Authors Victoria Ankarcrona
Daniel Altman
Anna-Karin Wikström
Bo Jacobsson
Sophia Brismar Wendel
Published in Acta obstetricia et gynecologica Scandinavica
Volume 98
Issue 9
Pages 1195-1203
ISSN 1600-0412
Publication year 2019
Published at Institute of Clinical Sciences, Department of Obstetrics and Gynecology
Pages 1195-1203
Language en
Links dx.doi.org/10.1111/aogs.13614
www.ncbi.nlm.nih.gov/entrez/query.f...
Subject categories Obstetrics and gynaecology

Abstract

The number of women postponing childbirth until an advanced age is increasing. Our aim was to study the outcome of labor in nulliparous women ≥40 years, compared with women 25-29 years, both after spontaneous onset and induction of labor.The nationwide population-based Swedish Medical Birth Register was used to study the perinatal outcome in nulliparous women with a singleton, term (gestational week 37-44), live fetus in cephalic presentation and a planned vaginal delivery from 1992 to 2011. We included 7796 nulliparous women ≥40 years and 264 262 nulliparous women 25-29 years. Prevalence and risk of intrapartum cesarean section, operative vaginal delivery, obstetric anal sphincter injury, and 5-minutes Apgar score <7 were calculated for women ≥40 years stratified for spontaneous onset and induction of labor, using women 25-29 years as the reference in both strata. Crude and adjusted odds ratios (aOR) were calculated by unconditional logistic regression and presented with 95% confidence intervals (CI).Overall, 79% of women ≥40 years with a trial of labor reached a vaginal delivery. After spontaneous onset, intrapartum cesarean section was performed in 15.4% of women ≥40 years compared with 5.4% of women 25-29 years (aOR 3.07, 95%CI 2.81 to 3.35). Operative vaginal delivery was performed in 22.3% of women ≥40 years compared with 14.2% of women 25-29 years (aOR 1.71 95%CI 1.59 to 1.85). After induction of labor, an intrapartum cesarean section was performed in 37.2% women ≥40 years compared with 20.2% women 25-29 years (aOR 2.51, 95%CI 2.24 to 2.81). Operative vaginal delivery was performed in 22.6% of women ≥40 years compared with 18.4% women 25-29 years (aOR 1.45, 95%CI 1.28 to 1.65). The risk of obstetric anal sphincter injury or 5-minutes Apgar score <7 was not increased in women ≥40 years, regardless of onset of labor.Trial of labor ended in vaginal delivery in 79% of nulliparous women ≥40 years. The risks of intrapartum cesarean section and operative vaginal delivery were higher in women ≥40 years compared with women 25-29 years, both after spontaneous onset and induction of labor. The risk of obstetric anal sphincter injury or 5-minutes Apgar score <7 was not increased. This article is protected by copyright. All rights reserved.

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