Very advanced maternal age

M R C O G PA R T 2 · S O S P O C K E T C A R D · K N O W L E D G E A R E A 5 – A N T E N ATA L C A R E

Very Advanced Maternal Age Howell A, Blott M. Very advanced maternal age. TOG 2021;23:38–47. doi:10.1111/tog.12710

≥45 yrs 53% 1:4 DEFINITION OF VAMA AT DELIVERY OVERALL MISCARRIAGE RISK IN VAMA PPH RISK IN VAMA

DO N' T-M IS S FA C TS

  1. vAMA = maternal age ≥45 years at delivery; 78% conceive via ART, 91% of these via egg donation

  2. Offer low-dose aspirin 150 mg from 12 weeks to delivery in all vAMA women (ART or spontaneous)

  3. PPH affects 1 in 4 vAMA women – the single most significant complication regardless of parity/plurality/conception method

  4. ART conception carries 23.3% risk of delivery <36 weeks and 22.1% risk of birthweight <2500 g (vs 9.3%/7.4% spontaneous)

  5. Primiparous vAMA women are 8× more likely to have a caesarean than women 30–34 years; ART conception 6× more likely

  6. 33.5× ↑ ICU admission; admission alone ↑ VTE risk 12-fold – reassess VTE risk at every opportunity

  7. Term trisomy 21 risk: 1:35 at 45 years, 1:25 at 49 years; combined test detection rate 95% in vAMA with own embryos (highest of any age group)

  8. Only proven stillbirth-prevention strategy is timed delivery – consider by 38 weeks in women ≥44 years; recommend serial growth scans + Doppler from 26–28 weeks

KEY RISK MULTIPLIERS VS YOUNGER WOMEN

PPH 4× transfusion need ICU admission 33.5× Placenta praevia/abruption 3× Ectopic 3× overall risk

Congenital anomaly rate unchanged (1.9% vs 1.5%)

ABBREVIATION KEY

vAMA — very advanced maternal age (≥45 years at delivery) PPH — postpartum haemorrhage

ART — assisted reproductive technology ICU — intensive care unit

HFEA — Human Fertilisation and Embryology Authority NICU — neonatal intensive care unit

FGR — fetal growth restriction NICE — National Institute for Health and Care Excellence

SGA — small for gestational age PAPP-A — pregnancy-associated plasma protein-A

GDM — gestational diabetes mellitus NIPT — non-invasive prenatal testing

VTE — venous thromboembolism BMI — body mass index

Source: The Obstetrician & Gynaecologist (TOG), RCOG journal — Howell A, Blott M. Very advanced maternal age. TOG 2021;23:38–47. doi:10.1111/tog.12710

Clinically reviewed by NHS obstetricians and gynaecologists

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