Advanced maternal age and pregnancy.

In Ghana obstetricians analyzed data on 624 pregnant women 40 years or older who were admitted to Korle-Bu Teaching Hospital in 1993 to determine why women of advanced age still become pregnant and the effect of advanced maternal age on pregnancy outcome. 428 (68.6%) delivered after 28 weeks gestational age. 188 (30.1%) had complicated abortions. Eight (1.3%) had gestational trophoblastic disease. Only 11.4% of the 624 women really wanted to be pregnant. 59.8% definitely did not want to be pregnant. Only 11 (1.8%) women used contraception. 30.3% had been married more than once. The 428 women who delivered after 28 weeks gestational age comprised 3.6% of all deliveries at the hospital. Their mean age was 41.7 years (40-50). This was the first pregnancy for only 1 woman. Mean parity was 5.6 (range 0-12). The advanced maternal age women had a significantly lower cesarean section rate than younger women (14.7% vs. 18.2% for all age groups combined; p < 0.05). They were also less likely to experience instrumental deliveries (1.4% vs. 2.6%; p < 0.05). On the other hand the advanced maternal age group was more likely to have a fetal malpresentation delivery than the younger group (7.5% vs. 3.2%; p < 0.05). The premature birth rate was 9.2% for the advanced age group which was not significantly different from that of the younger group. The advanced age group had a higher stillbirth rate than the younger group (13.7% vs. 6.7%; p < 0.05). The older mothers faced a higher risk of maternal mortality than the younger mothers (21 vs. 9.3/1000 deliveries; p < 0.05) reflecting the nonattendance and irregular attendance for prenatal care late booking and later reporting in labor among these women. The leading reasons for continued childbearing at 40 and beyond included ignorance low use of contraceptive methods and remarriage.