Vaginal Delivery in a Cohort of Pregnant Women Aged 40 or Older

Research Article

Austin J Obstet Gynecol. 2014;1(1): 6.

Vaginal Delivery in a Cohort of Pregnant Women Aged 40 or Older

Rotar IC1,2, Dumitras DE3, Muresan D1,2, Cotutiu P2, Giurgiu C2 and Stamatian F1,2*

1Department of Obstetrics and Gynecology, University of Medicine and Pharmacy "Iuliu Ha?ieganu", Romania

2Department of Obstetrics and Gynecology, Emergency County Hospital, Romania

3Department of Economic Sciences, University of Agricultural Sciences and Veterinary Medicine, Romania

*Corresponding author: Stamatian F, First Clinic of Obstetrics and Gynecology, 3-5 ClinicilorStreet, Cluj- Napoca, Romania

Received: June 20, 2014; Accepted: July 14, 2014; Published: July 16, 2014


Aim: Delivering after the age of 40 years can be challenging. Worldwide, compared to previous decade, the number of deliveries in this particular category of age is increasing constantly. The goal of the present study was to analyze the outcome of vaginal delivery in this category of patients.

Materials and methods: A retrospective study was performed in The First Clinic of Obstetrics and Gynecology, Cluj-Napoca, Romania between 1st of January 2012 and 31st of December 2012. All deliveries that took place in the above mentioned hospital in the mentioned period were included in the study.

Results: A significant increased number of Cesarean sections were observed in the group of older patients. The duration of the active phase was shorter in ≥40 years old primiparas than in <40 years old primiparas and similar to younger patient group for parity ≥2. The Apgar score and the fetal weight were not influenced by the maternal age. Regardless of parity, the frequency of the episiotomy practice was similar in women ≥40 years old and <40 years old.

Conclusion: Vaginal delivery is still a valid option for women 40 or older.

Keywords: Vaginal delivery; Cesarean section; Delivery route


VD: Vaginal Delivery; CS: Cesarean Section; SD: Standard Deviation; h: Hours; min: Minutes; WA: Weeks of Amenorrhea; GA: Gestational Age; p1: Primiparas; p2: Secundiparas; p3: Multiparas; <0: Patient aged less that 40 years at delivery; ≥40: Patient aged 40 years or older at delivery


Over the past years a trend of increasing age at the delivery of the first child has been observed [1]. In May 2014, a report published by the Centers for Disease Control and Prevention has shown in the United States [1] the birth rates in the maternal age category 40 to 44 years old increased more than 4-fold from 1985 to 2012 (from 0.5 to 2.3 per 1000 women). This trend was also observed in the United Kingdom and Romania [2-5].

Childbearing after 40 years has been associated with an increased number of complications throughout pregnancy and peripartum [6]. The social trend, with women demands to accomplish their studies and to get a specific job leading to a delayed pregnancy, and currently effective and available contraceptive methods that allow the occurrence of a pregnancy in the moment chosen by the couple [7], represent the main reasons for this delay. Additionally, the development and the accessibility to assisted reproduction techniques have given couples considered previously incapable of conceiving the chance for a pregnancy to happen [2,8].

The present study aims to describe the parameters of vaginal birth in women ≥40 years old and to compare these parameters with those observed in women <40 years old.

Materials and Methods

A retrospective analysis of all births that took place in the 1st Clinic of Obstetrics and Gynecology, Emergency County Hospital, Cluj-Napoca, Romania (a university teaching hospital) during 12 months (year 2012) was performed. 1,872 patients were included in the study. The multiple pregnancies (84 patients) were excluded from further analysis. All patients with breech presentation or transverse lie delivered by cesarean section (CS) were excluded from the vaginal birth analysis.

For statistical purposes, based on the age at delivery, the patients were divided in two groups: <40 years old (n=1744) and ≥40 years old (n=45). For each patient, the following parameters were collected: age, gravidity, parity, delivery route, neonatal parameters (weight, Apgar score, sex). In patients who delivered vaginally, the following supplementary parameters were analyzed: duration of dilatation period, duration of expulsion, duration and type of expulsion, use of episiotomy, vaginal or cervical laceration. The data were included in a Microsoft Excel 2007 file and later analyzed using STATA Intercooled 10 (Stata Corp, College Station, Texas). Student's t-test and chi-square test were used where appropriate for comparing the parameters in the different patient groups. A p-value of <0.05 was considered statistically significant.

Results and Discussion

The present analysis focused on all singleton deliveries (n=1,744).

Maternal age

The average age in the study group was 29.90 years (SD: 4.80); the youngest patient was 13 years old and the oldest was 45 years old at delivery. Patients' distribution based on age is presented in Table 1. In the sample included in the analysis, the majority of the women were 30-34 years old (636 cases; 35.57%). The most frequent age to deliver in this particular maternity in 2012 was 30 years old (147 cases; 8.22%).