The Impact of Antenatal Testing for Advanced Maternal Age on Cesarean Delivery Rate at an Urban Institution

Lisa D. Levine; Sindhu K. Srinivas; Emmanuel Paré; Shilpi S. Mehta-Lee

doi:10.1055/s-0034-1376312

American Journal of Perinatology, Table of Contents

Am J Perinatol 2015; 32(01): 101-106
DOI: 10.1055/s-0034-1376312

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Impact of Antenatal Testing for Advanced Maternal Age on Cesarean Delivery Rate at an Urban Institution

Authors

Lisa D. Levine

¹Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
Sindhu K. Srinivas

¹Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
Emmanuel Paré

²Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
Shilpi S. Mehta-Lee

³Department of Obstetrics and Gynecology, New York University School of Medicine, Maternal Fetal Care Center, New York, New York

Abstract

Objective Antenatal testing has been implemented for advanced maternal age (AMA) women given their increased stillbirth risk. Our objective was to evaluate cesarean delivery and induction rates after the start of antenatal testing at our institution.

Study Design A retrospective cohort study of AMA women (≥ 40 years) who delivered at our institution was performed. Testing for AMA began in 2005. AMA women who delivered before (unexposed) and after (exposed) the implementation were compared. Our primary outcome was cesarean delivery and secondary outcome was induction. Chi-square compared categorical variables and multivariable logistic regression calculated odds ratio (OR) and controlled for confounders.

Results A total of 276 women were included (147 unexposed and 129 exposed). The cesarean rate was higher in the exposed group (53 vs. 39%, OR 1.76 [1.09–2.84]). The increased risk of cesarean remained after adjusting for race, previous cesarean, multiple gestations, and parity (adjusted OR 1.85 [1.05–3.28]). When excluding those with previous cesareans, the risk of primary cesarean was not significant (OR 1.57 [0.89–2.76]). The induction rate was not different (38 vs. 33%, p = 0.4).

Conclusions While overall cesareans increased, there was no difference in primary cesarean and induction rates for AMA women after implementation of antenatal testing for AMA.

Keywords

advanced maternal age - antenatal testing - cesarean - induction

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References

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