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Age related increase in uterine dysfunction during labor
Title: The relationship between maternal age and uterine dysfunction: A continuous effect throughout reproductive life
Author: D. Main, et al.
Address: San Francisco, CA
Source: American Journal of Obstetrics and Gynecology 183:1312-1320 (November) 2000
Summary: This study was undertaken to determine whether there is a continuous effect of maternal age on uterine function. Using a comprehensive computerized database and medical record system, researchers identified 8496 low risk patients who were nulliparous and in spontaneous term labor with singleton fetuses in vertex presentation. Subjects were analyzed according to maternal age for measures of labor dysfunction and rates of operative delivery. The use of oxytocin, duration of second stage of labor, cesarean delivery, cesarean delivery for failure to progress and operative vaginal delivery rates were significantly increased with advancing maternal age. These increases appeared to be continuous functions beginning during the early 20s instead of a new phenomenon beginning after age 35. Researchers concluded that among nulliparous patients with uncomplicated labor there is a continuously increasing risk of uterine dysfunction related to maternal age.
Comment: On analysis of a large number of studies on the adverse effects of aging on pregnancy and labor, there are three risks that seem to stand out as incontrovertible. There is an increased risk of spontaneous abortion / chromosomal abnormalities and there is an increased risk of C-section. Some have stated this is because of the increased incidence of fibroids and anatomic abnormalities. Others have proposed that there is a greater propensity for the obstetrician to intervene because of perceived risk. When both of these are excluded, C-section rates are still higher and seem to be related to uterine dysfunction.