Advanced Maternal Age and Perinatal MortalityFitrisia Rahma030 08 105

INTRODUCTIONAdvanced Maternal Age pregnancy after the age of 35Nowadays, the number of women having a baby on the age of 35 and more is higher than before for a variety of reasons The older women is more likely to request preconceptional counseling

INTRODUCTIONAfter age 35, women are at increased risk for obstetrical complications as well as perinatal morbidity and mortality Older women who have a chronic illness or are in poor physical condition have more risks Advanced maternal age was associated with a higher rate of stillbirth

INTRODUCTIONPerinatal mortality: period leading up to birth and the first week of life largely due to obstetric causes Advanced Maternal Age and Perinatal MortalityMore than one third of stillbirths take place during delivery and are largely avoidable The perinatal mortality rate is five times higher in developing than in developed regions

MATERIAL AND METHODResearch design: Cross-sectional study Pulo Mas streets, East Jakarta July 2011.Population and sample:Women who had given birth to a child after and before the age of 35.Data collection: Data were collected through the questioner

MATERIAL AND METHODInclusion and exclusion criteria: The women do not have illness during pregnancy (diabetes, hypertension, eclampsia, preeclampsia, and infection)The baby does not have twin, was not at abnormal position in the uterus, and born without operational deliveryStatistical analysisThe women were categorized into two groups: women who had given birth to a baby before 35 years oldwomen who had given birth to a baby on the age of 35 and more

MATERIAL AND METHODThe statistical formula for Fishers exact test was applied with the significant level set at p0.05The calculation was performed manually.Ethical ClearanceWritten consent was included

QUESTIONERA. IdentityNameAgeOccupationB. QuestionsIn what age did you given birth to your baby/ies?How many times have you given birth to before the age of 35 (dead or alive)?How many times have you given birth since the age of 35 (dead or alive)?

QUESTIONERHow many babies have you given birth to since the age of 35 (dead or alive)?In what age did you deliver the baby/ies (after 35 y.o.)?Child 1 was born when you were ___ years oldChild 2 was born when you were ___ years oldEtc.*These questions under are related to Child 1Was the baby born alive?

QUESTIONERIf the answer above is NO, did the baby die before or after they were born?Are your children twins?Were they at abnormal position in the uterus before the delivery?Were they born normally or with operational delivery?

QUESTIONER*These questions under are related to your condition when you were having your Child 1Do you have diabetes?Do you have high blood pressure?Did you have high blood pressure with proteinuria?Did you have high blood pressure with proteinuria and seizure?Did you have any infection?(*Same questions for Child 2, etc.)

RESEARCH RESULTOf 34 women who participated in this study, 14 of them were not analyzed because they did not fulfill study criteria

VariablePerinatal MortalityBorn AliveTotal 35 y.o.5510< 35 y.o.1910Total61420

Fishers Exact Test2 = d! h! n1! n0! n! d1! h1! d0! h0!P = 2 ( first value + smallest value)

Table 1: 2=0,0054 Table 2: 2=0,0650

Table 3: 2=0,2438 Table 4: 2=0,3715

Table 5: 2=0,2438 Table 6: 2=0,0650

Table 5: 2=0,2438 Statistical AnalysisFirst value = 0,0650Smallest value = 0,0054P = 2 ( first value + smallest value) = 2 ( 0,0650 + 0,0054 ) = 0,1408

RESEARCH RESULTStatistical analysis results p=0.1408(p>0.05) means There is no significant association between advanced maternal age and perinatal mortality

DISCUSSIONHaving a baby in the age more than 35 increases the risk and complication Affect the perinatal mortality Statistical analysis shows that there is no significant association Advanced maternal age is associated with higher rate of stillbirths It has association with physiology of aging

DISCUSSIONDecreased myometrial efficiency occurs with aging cause pregnancy complications including perinatal death There are some risks of being pregnant in advanced age that have to be taken care of Good antenatal care and operative delivery might reduce the risk

DISCUSSIONSocialize the effect of having a baby in advanced maternal age Socialize about proper antenatal care that they should take to reduce the risks

ReferencesMarch of Dimes. Pregnancy After 35. Available at: http://www.marchofdimes.com/trying_after35.html#. Accessed on: May 29th 2011.Expectant Mothers Guide to St. Louis. Schurk, MK. Advanced Maternal Age, Pregnancy after Age 35. Available at: http://www.expectantmothersguide.com/library/stlouis/ESLadv_maternal_age.htm. Accessed on: May 25th 2011.

ReferencesCunningham FG, et al. Williams Obstetrics 22th edition. McGRAW-HILL Medical Publishing Division. 2005. P 194.Medscape News. Franz MB, Husslein PW. Obstetrical Management of the Older Gravida: Stillbirth and Perinatal Mortality. Available at: http://www.medscape.com/viewarticle/721313_5. Accessed on: June 23rd 2011.

ReferencesWorld Health Organization. Neonatal and Perinatal Mortality Country, Regional, and Global Estimates. 2006.Goldman JC, et al. Impact of Maternal Age on Obstetric Outcome. 2005.