Induction of labour at an earlier stage of gestation in women of advanced maternal age may reduce the risk of stillbirth and neonatal complications, say experts from the Royal College of Obstetricians and Gynaecologists (RCOG) in a new Scientific Impact Paper (SIP).
The College’s Scientific Advisory Committee (SAC) has released the paper Induction of labour at term in older mothers, which looks at a collection of studies exploring the rising age of mothers and the effects on fetal and maternal outcomes.
The average maternal age in the UK has risen dramatically over the past two decades, with statistics showing that between 1987 and 2008 maternities in women aged 35 or over rose from 8% to 20% and maternities in women aged 40 years or older trebled from 1.2% to 3.6%.
Numerous studies have shown a link between rising maternal age and the increased risk of obstetric complications including placental abruption, placenta praevia, postpartum haemorrhage and preterm delivery. However, advanced maternal age is also strongly associated with an increased risk of stillbirth and neonatal death.
This paper looks at a number of epidemiological studies that have identified a link with gestation time and maternal age influencing the risk of stillbirth and adverse fetal outcomes.
Data from these studies show the risk of stillbirth at 39-40 weeks gestation is doubled for women aged 40 years or over, and at 39 weeks gestation these women (40+ years) have a similar stillbirth risk to women aged in their late 20s at 41 weeks gestation.
Induction of labour in older mothers is widely practiced and a Cochrane review found that induction of labour at 41 weeks gestation results in improved perinatal outcomes generally without increasing the caesarean section rate.
Despite commonly held beliefs, when induced, vaginal births still remain more likely than emergency caesarean sections in women of all ages.
Dr Mandish Dhanjal, Imperial College Healthcare NHS Trust and co-author of the paper, said:
“Induction of labour in older mothers is a common method of intervention perceived to reduce the risk of stillbirth.
“While the mechanism for an excess risk of stillbirth in women of advanced maternal age is still fairly unknown, the findings collaborated in this paper provide a strong argument for an early induction of labour.”
Dr Anna Kenyon, University College London Hospital and co-author of the paper, added:
“It is justifiable for experts to conclude that inducing labour at an earlier stage of gestation (39-40 weeks) in older mothers (40+ years) could prevent late stillbirth and any maternal risks of an ongoing pregnancy, without increasing the number of operative vaginal deliveries or emergency caesarean sections.
“Further research is required to more clearly define the effect of induction of labour in women of advanced maternal age.”