| ObjectivesTo evaluate the status of the advanced maternal age from 2012 to 2016,and to analyze the delivery outcomes related with the advanced maternal age at different two-child policies,different age groups and different parities,then explore the factors influencing the adverse delivery outcome,as well as to provide scientific basis for the further effective intervention to reduce the occurrence of adverse outcome,thus improve the health care level of our country.MethodsA retrospective study was used to investigate the medical records of 3,355 elderly parturient women who were hospitalized in a third-grade hospital in Shandong province from 2012 to 2016.Analyze the general demographic data and the incidence of the advanced maternal age in the last five years under the two-child policy of this hospital.Comparing each group with respect to the pregnancy complications and comorbidities,perinatal outcomes,mode of delivery,hospital stays d and hospitalization costs under the different two-child policies(double alone two-child policy,selective two-child policy,universal two-child policy),different age groups(35～39,40～44,≥45)and different parities(primiparity,pluriparity),explore the factors influencing the adverse delivery outcome of the advanced maternal age.Statistical analysis was conducted with SPSS 20.0 software package.The statistics included:independent samples t test,one-way analysis of variance,chi-square test,univariate and multivariate Logistic regression analysis.Results1.The incidence of advanced maternal ageThe incidence rate of advanced maternal age from 10.68 percent in 2012 to 20.98 percent in 2016,from 11.48 percent under the policy of "double alone two-child policy" to 20.98 percent under the "universal two-child policy".The incidence rate of elderly pluripara is higher than elderly primipara.The incidence rate of advanced maternal age of all age groups is on the rise.2.Pregnancy complications and comorbiditiesAlong with the birth policy changes,the incidence rate of hypertensive disorders complicating pregnancy,gestational diabetes mellitus,premature rupture of membrane,test-tube baby and scarred uterus,uterine myoma,thyroid disease is increased,while the incidence rate of cord abnormality and diabetes mellitus complicated pregnancy is declined(P<0.05).The incidence rate of pregnancy complicated with hypertensive disorders complicating pregnancy,gestational diabetes mellitus,abnormal position,placental abruption,premature and heart disease,uterine myoma is increased with maternal age growth(P<0.05).The incidence rate of hypertensive disorders complicating pregnancy,placenta previa,premature delivery and scarred uterus,heart disease,chronic liver disease of the elderly pluripara is higher than that of the elderly primipara,while the incidence rate of cord abnormality,multiple pregnancy,test-tube baby and uterine myoma,thyroid disease is lower than that of the elderly primipara(P<0.05).3.Perinatal outcomesAs the fertility policy changes,the incidence rate of stillbirth is significantly decreased(P<0.05),gender distribution of newborn tends to balance(P<0.05).The incidence of low birth weight,stillbirth,neonatal death is increased with the growth of age for the advanced maternal age(P<0.05),there is a statistically significant difference for the incidence of fetal distress of all ages(P<0.05).The incidence rate of low birth weight and neonatal asphyxia of the elderly pluripara is higher than that of the elderly primipara,while the incidence rate of fetal distress is lower than that of the elderly primipara(P<0.05).4.Mode of deliveryThere is no statistically significant difference between the three delivery modes under the different fertility policies(P>0.05).As the age increases,the rate of cesarean section gradually increased,the rate of vaginal delivery gradually declined(P<0.05),the rate of cesarean section and assisted vaginal delivery of the elderly primipara is higher than that of elderly pluripara(P<0.05).5.The indicators of social economicAs the birth policy changes,the average length of hospital stay is gradually shortened,while the average hospitalization cost is gradually increased(P<0.05).With the increase of age,the average length of hospitalization is gradually increased,and the average hospitalization cost gradually increased(P<0.05).The average hospitalization stay of the elderly pluripara is shorter than that of the elderly primipara,and the average hospitalization cost is higher than that of the elderly primipara(P<0.05).6.Risk factors for adverse delivery outcomeThe main risk factors that might affect adverse pregnancy outcome were multiple pregnancy(OR=13.585,95%CI:8.478-21.796),placental abruption(OR=10.985,95%CI:4.672-25.830),placenta previa(OR=7.999,95%CI:5.552-11.523),hypertensive disorders complicating pregnancy(OR=7.418,95%CI:5.571-9.172),premature rupture of membrane(OR=3.422,95%CI:2.686-4.359),fetal distress(OR=2.554,95%CI:1.756-3.715),household registration(OR=2.669,95%CI:2.138-3.334),occupation(OR=1.809,95%CI:1.440-2.273).Conclusions1.There is a significant upward trend in the advanced maternal age under the different two-child policy,especially those aged between 35 and 39 years old,the incidence rate of elderly pluripara is higher than elderly primipara.2.As the birth policy changes,the incidence rate of advanced maternal age complicated hypertensive disorders complicating pregnancy,gestational diabetes mellitus,premature rupture of membrane,test-tube baby,scarred uterus,thyroid disease,uterine myoma is increased,while the rate of stillbirth is gradually declined,and gender distribution of newborn tends to balance.There is no difference between the three delivery modes under the different fertility policies.However,the average length of hospital stay of advanced maternal age is gradually shortened,while the average hospitalization cost is gradually increased.3.The incidence rate of advanced maternal age complicated hypertensive disorders complicating pregnancy,premature delivery,abnormal position,placental abruption and uterine myoma is increased with maternal age growth,and the incidence rate of stillbirth and neonatal death is gradually risen with the maternal age increased,as well as the rate of cesarean section,the average hospital stay and the average hospitalization expense.4.The incidence rate of hypertensive disorders complicating pregnancy,placenta previa,premature delivery,scarred uterus,heart disease,chronic liver disease and low birth weight,neonatal asphyxia,of the elderly pluripara is higher than that of the elderly primipara,while the incidence rate of cord abnormality,multiple pregnancy,test-tube baby,uterine myoma,thyroid disease and fetal distress is lower than that of the elderly primipara.The rate of cesarean section and assisted vaginal delivery of elderly pluripara is lower than that of elderly primipara.The average hospital stay of elderly pluripara is shorter than that of elderly primipara,while the average hospitalization cost is higher than that of elderly primipara.5.Multiple pregnancy,placental abruption,placenta previa,hypertensive disorders complicating pregnancy,premature rupture of membrane,fetal distress,household registration,occupation are risk factors for the adverse delivery outcome of advanced maternal age. |
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