Flashcards in Advanced maternal age Deck (14)
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%:
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?
What is the RR of placenta praevia?
What is the RR of PE?
What is the OR of GDM?
List the late pregnancy complications AMA women are at increased risk of
- Stillbirth (0.9% >40; 1% >50 vs 0.5% <40)
- 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
- IOL 39 weeks
- Consider elective CS if very AMA