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Flashcards in Advanced maternal age Deck (14)
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What are the benefits of AMA?

• Improved health and development in their children.
• Improved cognitive ability of children.
• Emotional and financial stability for children.


What is the risk of spontaneous miscarriage with AMA and what is the pathophysiology for this?

Spontaneous miscarriage risk c.f. <30 11%:
>=35: 25%
>=40: 50%
>=45: 90%

Majority due to chromosomal anomalies; >50% are T21.

Oocytes have been suspended in Metaphase I: susceptible to oxidative stress and telomere damage.


What is the age specific risk for Down syndrome?

Age 20: 1 in 1500
Age 30 : 1 in 900
Age 40: 1 in 150
Age 45: 1 in 28


What is the age specific combined risk of T13, T18 and T21 on CVS?

○ C.f. 20 1:705
○ 35 1:180
○ 40 1:39
○ 45 1:14


How much higher is the AMA risk of ectopic pregnancy and why?

3 x higher.
Due to accumulation of risk factors: multiple sexual partners, pelvic infection and tubal pathology.


Why is the incidence of multiple pregnancies higher in AMA?

- Rising FSH levels resulting in more than one dominant follicle developing.
- Old ovum with fragile zona pellucida leads to two separate points of regrowth and splitting of the fertilized ovum.
- Increasing ART use


What is the RR of HTN disorders in pregnancy?

RR 4


What is the RR of placenta praevia?

RR 3


What is the RR of PE?

RR 2.5


What is the OR of GDM?

OR 3.7


List the late pregnancy complications AMA women are at increased risk of

- Stillbirth (0.9% >40; 1% >50 vs 0.5% <40)
- PE
- Placenta praevia, accreta and abruption
- CS RR 4


What pre-conceptual counselling would you provide to a woman of AMA wanting to become pregnant?

- Warn of increased risks.
- Optimisation of medical conditions first: diabetes, HTN, obesity.
- Start pre-conception folic acid and iodine.

If using ART: only put one embryo back to minimise chances of multiple pregnancy.


How would you manage an AMA woman differently in the antenatal period?

- Aneuploidy screening recommended: MSS-1 or NIPT (NIPT has higher sensitivity and specificity).
- Low dose aspirin from 12 weeks until 36 weeks.
- Warn about increased risk of GDM and PET and alter surveillance accordingly.
- GDM screening: consider first trimester screening.

Stillbirth risk reduction:
- Monitor FMs
- Sleep on sides
- Consider serial growth scans
- Smoking cessation

Delivery timing:
- IOL 39 weeks
- Consider elective CS if very AMA


What postnatal advice would you give an AMA woman?

Interpregnancy interval of 12-18 months is associated with a reduction in maternal death