Very advanced maternal age TOG 2020

Question 1

What is considered very advanced maternal age

Answer 1

> 45

Question 2

ART autologous conception rate at age 45 and >46

Answer 2

45 2.9% in a cycle
>46% 0%

Question 3

In vAMA + ART with oocyte - risk of PET, delivery < 36 weeks & LBW <2500g

Answer 3

Question 4

vAMA, risk miscarriage & ecopticn

Answer 4

Miscarriage 53%
Ectopic 7%

Question 5

If spont conception risk T21

Answer 5

o 45 1:35
o 40 1:25

Question 6

Risk of multiple pregnancy

Answer 6

• Higher risk of multiple pregnancy 80/1000 vs 15/1000 all women
• 48yrs + 50% double embryo have multiple preg

Question 7

vAMA + multiple pregnancy risk
Born < 37/40
Need intubation
Admitted NNU

Answer 7

Born < 37/40 65%
Need intubation 2-4 x
Admitted NNU 1.5-3X

Question 8

vAMA + multiple pregnancy risk
Blood transfusion/ITU
PIH
PET
GDM

Answer 8

Blood transfusion/ITU 10-42%
PIH 26-32%
PET 10-35%
GDM 80-92%

Question 9

Reducing risk vAMA

Answer 9

Aspirin, umbilical artery doppler 26-28 weeks, regular BP monitoring in 3rd trimester, consider VTE
OGTT
Tx anaemia + active 3rd stage
Anaesthetic referral

Question 10

Flow diagram explaining care for vAMA - singleton/multiple

Answer 10