Pregnancy Outcomes of Elderly Primigravidae in a Tertiary Hospital in West Africa: A Retrospective Cohort Study.

Abstract

Elderly primigravidae refers to women who become pregnant for the first time from age 35 years and above. Advanced maternal age is a known risk factor for numerous maternal and perinatal complications. This study sought to determine pregnancy outcomes of elderly primigravidae at the Korle-Bu Teaching Hospital (KBTH). A retrospective cohort study was conducted. Women who had their first delivery at KBTH from January 1, 2015 to December 31, 2017 had their demographic and obstetrics and gynecology history and maternal and fetal outcomes retrieved from the department's electronic database. Women aged 35 years or more who had their first delivery within the study period constituted the exposed, whereas those between 20 and 34 were considered unexposed. Modified Poisson regression with robust error variance estimation and the log link function between the sociodemographic and obstetric factors and maternal and fetal outcomes to estimate adjusted risk ratios (aRRs) and 95% CI were used. Of 29,243 total deliveries, elderly primigravidae constituted 1.81% (530/29,243). Maternal outcomes associated with elderly primigravidae were increased incidence of Caesarean section or instrument delivery (aRR [95% CI] = 1.73 [1.56-1.92]) and prolonged length of stay in hospital (aRR [95% CI] = 1.14 [1.06-1.23]). Fetal outcome associated with the elderly primigravidae was stillbirth (aRR [95% CI] = 1.91 [1.25-2.91]). Elderly primigravidae therefore require more intensive monitoring, even in the absence of any obvious maternal complications. These findings will help in counseling and in the shared decision-making for delivery of elderly primigravidae.