Obstetrical Management of the Older Gravida

Maximilian B Franz; Peter W Husslein

Disclosures

Women's Health. 2010;6(3):463-468. 

In This Article

Early Pregnancy

With increasing age, the risk of miscarriage increases. Approximately 13–15% of all pregnancies end in miscarriage with over 90% being early abortions before 12 weeks of pregnancy. A significant correlation between maternal age and miscarriage rates can be demonstrated. Whereas women aged 20–24 years have a miscarriage rate of approximately 10%, women aged 35–39 years have a risk of 25% and women aged 40–44 years have a 50% risk for miscarriage, which increases to more than 90% for women over 45 years of age.[5] This high miscarriage rate is one of the main reasons for decreasing fertility in older women. According to Heffner, karyotyping the products of conception after miscarriage demonstrates chromosomal abnormalities in two-thirds of the cases.[5] The association between maternal age and chromosomal abnormalities is well known and Hook et al. demonstrated a risk of having a child with Down syndrome of one in 1667 for women of 20 years of age compared with one in 106 at 40 years of age and one in 30 at 45 years of age.[6] Besides lowered fecundability, this elevated risk of chromosomal aberration together with the increased risk of miscarriage owing to other reasons that occur more often with advancing age (e.g., myomas and diabetes mellitus) represent the main reasons for lower fertility with increasing age.

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