| BackgroundElderly multipara is considered to multipara’s maternal age of≥35years at the estimated date of delivery. Because of the deep-going work of the new policy of family planning, the rising divorce rate, more multipara giving birth to the second child for the death of the first child for disease or accident and so on, the live birth rate for multipara of advanced maternal age has increased steadily.The increasing of the elderly multipara’s age and number of pregnancies have significantly increased risks for various complications and adverse pregnancy outcomes,especially the risks of abortion, premature delivery and fetal malformation. And the longer LDT of elderly multipara, the heavier neonatal weight, the higher rate of fetal macrosomia than elderly primipara and the increasing rate of caesarean section of multiparas lead to the increasing the rate of dystocia.The second procreation of advanced women will bring new challenge.So it is very important to investigate the effect of increasing maternal age and pregnant number on obstetric and perinatal outcomes, improving the level of perinatal health care and avoiding complication of gravid and neonatus and adverse pregnancy outcomes. ObjectivesTo investigate the difference of pregnancy complications,outcomes of perinatal infant and mode of delivery between elderly multiparas and elderly primiparas, elderly multiparas and younger multiparas;To give proper proposal of elderly multiparas’ maternal health care, guide the management of elderly multiparas’maternal health care and improve the pregnancy outcome.MethodsCases come from lying-in women in Women’s Hospital, School of Medicine, Zhejiang University from January2013to December2013,in which there were three groups:elderly multipara group,elderly primipara group and younger multipara group;Retrospective and comparative study were applied to the general situation, the last delivery mode,pregnancy complications,delivery mode, dystopia factors and neonatal outcomes,comparing with each group with respect to pregnancy complications,perinatal outcome of children and mode of delivery.Results1.Pregnancy complications:(1)Hypertensive disorders complicating pregnancy:elderly multipara group lower than elderly primipara group (P<0.01), higher than younger multipara group (P<10.01).(2)Gestational diabetes mellitusLelderly multipara group higher than younger multipara group(P<0.01),no statistical difference compared with elderly primipara group(P>0.05).(3)Placenta.previa:elderly.multipara.group.higher.than.elderly.primipara.group(P<0.05), no statistical difference compared with younger multipara group(P>0.05);Placenta acereta:elderly multipara group higher than elderly primipara group and younger multipara group(P<0.05).(4)Premature rupture of memberane:elderly multipara group higher than younger multipara group(P<0.05), no statistical difference compared with elderly primipara group(P>0.05).(5)Pregnancy with uterine myoma:elderly multipara group higher than elderly primipara group(P<0.05)and younger multipara group(P<0.01).2.The rate of abortion and premature delivery:The rate of abortion:no statistical difference compared elderly multipara group with elderly primipara group and younger multipara group on the rate of abortion (P>0.05); The rate of premature delivery:elderly multipara group higher than younger multipara group (P<0.05), but no difference compared with elderly primipara group(P>0.05).3.Neonatal outcomes:(1)Fetal macrosomia:elderly multipara group higher than elderly primipara group and younger multipara group(P<0.05).(2)FGR:elderly multipara group higher than younger multipara group(P<0.05), no statistical difference compared with elderly primipara group(P>0.05).4. Mode of delivery:The rate of caesarean section:elderly multipara group higher than younger multipara group(P<0.01), no statistical difference compared with elderly primipara group(P>0.05).5.LDT and Mode of delivery:(1)The rate of caesarean section, vaginal delivery and obsteric forceps:no statistical difference(P>0.05).(2)Incidence of which failed in vaginal delivery and transfer to cesarean section:LDT> lOyears’ higher than LDT5-10years’ and LDT<5years’(P<0.05).6. Indications of cesarean section:(1)In elderly multipara group, indication sequenced:scarred uterus, complications of pregnancy, social factors, fetal distress.(2)In elderly primipara group, indication sequenced:social factors, complications of pregnancy, fetal distress, abnormal fetal position. (3)In younger multipara group, indication sequenced:scarred uterus, complications of pregnancy, abnormal fetal position, social factors.Conclusions1.Compared elderly multiparas with elderly primiparas, the rate of HDCP was lower, but the rate of placenta previa, placenta acereta, uterine myoma increased; Compared elderly multiparas with younger multiparas, the rate of HDCP, GDM, premature rupture of memberane increased.So elderly multiparas need more screening, warning its adverse complications2.Elderly multiparas’ rate of abortion was higher than elderly primiparas’and younger multiparas’, but there was no statistical difference.So bigger sample content were needed to investigate deeper.3.Elderly multiparas had high incidence in premature delivery,fetal macrosomia and fetal growth restriction.So more antenatal care were needed to detect and treat the disease timely, avoiding to effect the quality of the neonatus.4.Elderly multiparas’rate of cesarean section higher than younger multiparas’.The chief indications of cesarean section of elderly multiparas was the scarred uterus and elderly primiparas was the social factors.So we should pay attention to the assessment and study of vaginal birth after cesarean of the elderly primiparas, to reduce the rate of cesarean section.5.Elderly multiparas’ interval time between this pregnancy and the last was longer (> lOyears), and LDT≥10years’had high incidence in failure of vaginal delivery and transfer to cesarean section, So for elderly multiparas, the management of the labor process should be enhanced. |
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