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Maternal and neonatal outcomes at delivery in nulliparous women with advanced maternal age

BMC Pregnancy and Childbirth volume 25, Article number: 270 (2025) Cite this article

Abstract

Background

The age at first delivery is rising leading to an increasing proportion of women with advanced maternal age (AMA) which is defined as greater than or equal to 35 years at time of delivery. Previous studies have associated AMA with adverse maternal and neonatal outcomes leading to an arbitrary increased rate of cesarean sections amongst AMA women without clear medical indications.

Objective

To determine the associations between AMA and adverse maternal and neonatal outcomes in nulliparous women in a large cohort.

Methods

Our retrospective cohort study looked at 44,295 nulliparous women (39,496 < 35years and 4,799 ≥ 35years) with term singleton gestation who delivered in the obstetrical units of Hadassah Medical Organization in Jerusalem, Israel, between 2003 and 2017. Data on maternal characteristics and outcomes, and neonatal outcomes were extracted from the electronic database. Outcomes were compared between women with AMA and women < 35 using Chi square, Fisher exact and t-tests. Multivariable logistic regressions estimated odds ratios (OR) for outcomes, controlling for confounders. We reported two-sided p-values, adjusted odds ratio (aOR), and 95% confidence intervals (CI).

Results

Women with AMA were more likely to have c-sections compared to women < 35 years in the whole study population (aOR:2.29, 95% CI: 2.13–2.47, p < 0.0001) including women having inductions (aOR:1.38, 95% CI:1.25–1.53, p < 0.0001). Self-requested c-sections were significantly higher among women with AMA (16.8% vs. 2.8%, OR:6.9, 95% CI:5.5–8.8). AMA did not increase the risk of postpartum hemorrhage (aOR: 0.82, 95% CI: 0.72–0.94) and decreased likelihood of instrumental delivery (aOR:0.81, 95% CI: 0.73–0.89, p < 0.0001). Fewer women with AMA had 3rd- and 4th-degree tears (0.35% for ≥ 35years vs. 0.71% for < 35 years, RR:0.50, 95% CI:0.29–0.87, p = 0.012). Women with AMA were more than three times likely to have an intrauterine fetal demise (RR:3.53, 95% CI:2.54–4.90, p < 0.0001), but were not more likely to have low neonatal 5-minute APGAR scores (RR:0.79, 95% CI: 0.43–1.46, p value:0.44) or NICU admissions (RR:0.84, 95% CI: 0.61–1.17, p = 0.30).

Conclusions

Management of nulliparous AMA patients should be based on obstetric considerations and not solely on AMA status. Shared decision making is preferred to reduce the risks associated with AMA.

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Introduction

Deliveries among women with advanced maternal age are on the rise especially in high income countries [1,2,3]. Advanced maternal age (AMA) is defined as maternal age ≥ 35 years at the time of delivery [4]. Improved assisted reproductive techniques, increased desire to pursue educational and career goals contribute to a delay in childbearing [5,6,7]. There was a 67% increase in birth rate among women aged 35–39 years in the US between 1990 and 2019 [8]. Among women aged 35–39 years in the US, birth rates for first births increased from 1.3 to 11.0 per 1,000 between 1973 and 2012. For women aged 40–44 years birth rates increased from 0.5 to 2.3 per 1,000 from 1985 to 2012 [9].

Contemporary studies evaluating pregnancy outcomes in women with AMA compared to younger women have shown association between AMA and adverse maternal outcomes such as cesarean sections (CD), antepartum hemorrhage, postpartum hemorrhage, pregnancy induced hypertension, and gestational diabetes [3, 10,11,12,13]. In one systematic review, AMA was suggested to be independently associated with increased CD rates [11]. Additionally, a study comparing younger women with AMA women who underwent induction of labor found no difference in maternal and perinatal outcomes among women [14] and another study showed that induction of labor was associated with a 30% reduction in the rate of CD amongst women with AMA (OR 0.7, CI 0.5–0.9, P < 0.03) [3].

Evidence on association of AMA and neonatal outcomes is unclear [2, 3, 10, 14,15,16]. One study found that AMA was associated with adverse neonatal outcomes including preterm, low birth weight, perinatal deaths, and low 5-minute APGAR score [10] while another study found no difference between both groups for neonatal outcomes such as five-minute APGAR scores, small for gestational age, intrauterine fetal demise (IUFD), and admission to neonatal intensive care units (NICU) [3].

Nulliparous women with AMA and their health providers often believe that their advanced age puts their babies at increased risk for unfavorable outcomes and so, they turn to adopt CD arbitrarily as a safer mode of delivery [17, 18]. One study reported 38% CD rate among nulliparous women ≥ 35 and 50% amongst nulliparous women ≥ 40years old [19]. However, CD is not without risk and CD without medical indication has significant higher odds for poor maternal outcomes compared to vaginal delivery [20]. Women with AMA undergoing planned elective CD have been shown to have higher risk of mortality (2.56/10,000 vs. 0.44/10,000, p = 0.01), and peripartum hysterectomy (OR: 1.81, 95% CI: 1.36–2.40, p = 0.01), compared to those having a planned vaginal delivery [21].International healthcare communities call for CD rates to be around 5–10% [22]. Rising CD rates for AMA women indicate a need for more evidence to help in risk-based clinical decision making. However, the complex interplay between AMA, mode of delivery, and adverse neonatal and maternal outcomes is not clear. Therefore, the purpose of this study is to determine the association between AMA and adverse outcomes (maternal and neonatal) amongst nulliparous women in a large cohort, with specific attention to mode of delivery.

Materials and methods

A retrospective cohort study used secondary data from the obstetric units of the two Hadassah Medical Centers belonging to the Hadassah Medical Organization in Jerusalem; Mount Scopus, and Ein Kerem. Ethical clearance was obtained from the Institutional Review Board of the Hadassah Medical Organization. Names and identification numbers of patients were concealed in the extracted data set to ensure anonymity of the data. A waiver of consent from Hadassah Medical Organization’s Institutional Review Board was obtained since our data was secondary data. Data were collected over a 15-year period from January 2003 to December 2017 and included all nulliparous women at term. All cases of multiple gestation, malpresentation, placenta previa, and other medical indications for CD without a trial of labor were excluded. Women with ages ≥ 35 years were grouped into the exposed study group while those with ages < 35 years were taken as control group. The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Data on maternal age at birth, gestational age, nature of pregnancy (spontaneous or by assisted reproductive technique), preeclampsia, gestational diabetes, induction of labor, epidural anesthesia, trial of labor, actual delivery mode, instrumental delivery, duration of second stage of labor, postpartum hemorrhage, third and fourth degree perineal tears, birth weight, length of hospitalization, IUFD, one minute and five minutes APGAR scores, and admission into NICU were extracted from the electronic database in an excel format. Second stage of labor was defined as prolonged if ≥ 2 h for deliveries without epidural anesthesia and ≥ 3 h for deliveries with epidural anesthesia and postpartum hemorrhage was defined as estimated blood loss after delivery ≥ 500 cubic centimeters for vaginal delivery or ≥ 1000 cubic centimeters after CD.

Data analysis was done using R version 4.1.1 software. Chi square and Fisher Exact tests were used to determine statistical significance of the associations between independent variables and categorical dependent variables. For the variable “length of hospital stay”, normality was assumed due to the magnitude of our sample size and a t-test of independent samples was used to compare the mean difference between the two groups. Covariates with p values less than 0.1 in a univariate analysis were included in a multivariable analysis model to control for confounding variables such as c-section, epidural use, induction, preeclampsia, gestational diabetes, assisted reproduction, third and fourth degree tears, and birth weight. Multivariable logistic regression and multiple linear regression were used for categorical and numerical outcome variables respectively. Statistical significance was assumed at a two-sided p-value of less than 0.05 with a confidence interval of 95%.

Ethical approval was obtained from the Institutional Review Board of the Hadassah Medical Organization. A waiver of consent was obtained on the basis of preserving individuals’ anonymity.

Results

A total of 149,928 deliveries were registered during the study period, of which 44,295 participants met the eligibility criteria, including 39,496 (89.17%) with age < 35 years and 4,799 (10.83%) with age ≥ 35 years. Figure 1 shows the flow chart for study group selection. We had missing data above 10% of total study population for three variables: assisted reproduction, prolonged second stage, and postpartum hemorrhage (11.4%, 11.5%, and 25% respectively).

Fig. 1
figure 1

Flow chart for selection of study population

Full size image

Table 1 below summarizes the distribution of maternal characteristics by maternal age for the whole study population and rate ratios with 95% CIs comparing AMA women to non-AMA women in bivariate analyses. The median age for the younger group was 26 and ranged from 17 to 34 years (mean: 26 ± 4 years) while for the AMA group, it was 37 and ranged from 35 to 53 years (mean: 38 ± 2 years). A lower proportion of women with AMA had a trial of labor compared to women < 35 years. The difference was significant and indicating an increased likelihood of cesarean section among women with AMA. Women with AMA were more likely to be induced, receive epidural anesthesia, have preeclampsia and gestational diabetes, and use assisted reproduction.

Table 1 Distribution of maternal characteristics by age comparing AMA women to non-AMA women in bivariate analyses
Full size table

Table 2 shows the distribution of maternal outcomes by maternal age, rate ratios and 95% CIs comparing women > 35 years to younger women in bivariate analyses. In the whole study population of women undergoing trial of labor and those for elective CD, the proportion of women with AMA (women aged ≥ 35) who delivered by CD was twice as high compared to the younger group (Table 2). Even among women who had a trial of labor and those with induction of labor, the rate of CD was higher among the AMA women when compared to the non-AMA women.

Among women who had CD, 127 out of 4,472 (2.8%) women in the younger group of women had a self-requested CD while 188 out of 1,116 (16.8%) women with AMA had a self-requested CD.

Interestingly, the proportion of instrumental delivery among AMA women was lower than in younger women (13.6% for ≥ 35years and 16.4% for < 35years) and the proportions of women with third- and fourth-degree tears (0.35% for ≥ 35years vs. 0.71% for < 35years), and prolonged second stage of labor (8.55% for ≥ 35years vs. 11.0% for < 35years) were lower among AMA women as well. In addition, the rate of postpartum hemorrhage was significantly lower in the AMA group compared to the younger group (9.2% for < 35 years and 7.9% for ≥ 35) but, after controlling for possible confounders, the difference was not found to be significant.

Table 2 Distribution of maternal outcomes comparing women ≥ 35 years to younger women in bivariate analyses
Full size table

Although we found an association between advanced maternal age and length of stay in both women who had a CD and those that delivered vaginally, the difference was not clinically significant thus multivariate linear regression was not done. Table 3 presents the results of multivariable logistic regression models. AMA was associated with CD, with aOR of 2.29 (95% CI: 2.13–2.47) for the whole study population. Weaker associations were found for women who had trial of labor or induction (aOR of 1.38 (95% CI: 1.25–1.53) and 1.47 (95% CI:1.23–1.75), respectively). Women with AMA had decreased aOR for tears, prolonged second stage, and instrumental deliveries. Women with AMA also had a lowered OR for postpartum hemorrhage compared with younger women.

Table 3 Adjusted odds ratios for birth outcomes in women ≥ 35 compared to women < 35 years at delivery
Full size table

Table 4 present the results of the univariate associations of AMA with neonatal outcomes. Maternal age ≥ 35 years was significantly associated with IUFD (RR: 3.53, 95% CI: 2.54–4.90). We found no association between AMA and low APGAR scores at 1- and 5-minutes. Furthermore, no association was found between AMA and NICU admission.

Table 4 Distribution of neonatal outcomes by maternal age for whole population
Full size table

Discussion

In this retrospective cohort study women who were ≥ 35 years old when they gave birth for the first time had an increased risk of CD compared to younger women. Self-requested c-sections were significantly higher among women with AMA. We found no increased risk of postpartum hemorrhage and a decreased risk of instrumental delivery. Fewer women with AMA had 3rd- and 4th-degree tears. AMA women were not found to have any difference in risk of low neonatal 5-minute APGAR scores or NICU admissions.

The significantly higher rate of CD among women with AMA is similar to that of many other studies [3, 10,11,12]. AMA has been identified as an independent risk factor for CD [11, 12] but this can certainly not explain in total, the high rates of CD among AMA women. Nulliparous women with AMA are certainly under pressure since their window of fertility gradually closes. One study reported that women tend to perceive CD as a safer mode of delivery for their babies than vaginal delivery [23]. In our study, self-requested CD rate was six times higher among women with AMA compared to the younger group although the reason for their self-requested CD could not be ascertained from our data. Another reason found in the literature for the high rate of CD among AMA women may be the “precious baby effect” in which rates of CD are higher among women who conceived by assisted reproductive techniques [24,25,26]. Self-requested CD may also be linked to obstetrician and maternal perception of neonatal safety through CD birth as compared to vaginal birth [27,28,29].

Our study found weaker associations between AMA and trial of labor, induction, prolonged second stage, instrumental deliveries, tears, and postpartum hemorrhage compared with younger women. This may be attributed to the higher likelihood a self-requested CD in AMA women.

The rate of instrumental delivery was lower among women with AMA compared to women in the younger group. This is contrary to findings reported by Jeong et al. in a study of maternal outcomes of women undergoing an induction of labor [14]. Authors reported a higher rate of instrumental delivery among women with AMA compared to those in the younger group (19.6% vs. 8.2%, p value = 0.043). This could be due to their relatively small sample size of 307 participants (73 in the AMA group and 234 in the younger group).

Alternatively, our study’s lower rate of instrumental deliveries may reflect variations in clinical practice, patient preferences, and institutional decision-making. Healthcare providers may have a lower threshold for cesarean sections in AMA patients due to perceived risks, while some AMA women may prefer elective cesareans to avoid potential complications. Socio-cultural factors, prior experiences, and differences in study populations and protocols may further explain the observed discrepancy beyond sample size considerations.

Our study also found that AMA women had a lower risk of having a prolonged second stage of labor. This is in contrast with previous studies that showed a positive correlation between duration of the second stage of labor and maternal age at time of delivery [30,31,32].

Women with AMA in our study had a significantly lower rate of third- and fourth-degree tears and were more than two-fold less likely to have a tear at all. Contrary to our findings, Jander et al. found a significant association between AMA and third- and fourth-degree tears [33]. Delivery at late hours and human factors such as reduced alertness of the practitioner and or lack of good provider-patient communication are known to be associated with tears but unfortunately could not be controlled for in our study.

We found a significantly lower rate of postpartum hemorrhage among women with AMA compared to their younger peers. Previous studies have not been consistent with results. One study using an objective method of evaluating postpartum hemorrhage by measuring the decrease in hemoglobin level after delivery, no significant difference was found in AMA [14]. In another, the proportion AMA women with postpartum hemorrhage was doubled (4.3% vs. 1.9%) [10]. Unlike the other studies, our sample size was considerably large and our definition for postpartum hemorrhage took into consideration the mode of delivery which contributes to the validity of our findings.

Our neonatal findings indicate that women with AMA were three times more likely to have an IUFD. Our findings are similar to those of Mehari et al. who found AMA women to be two and a half times more likely to experience IUFD compared to younger women [2, 10, 16]. AMA is a known risk factor for preeclampsia, gestational diabetes, as well as overt diabetes. These metabolic disorders are also associated with IUFD. AMA is also associated with increased chromosomal congenital abnormalities which also increase the risk of IUFD.

We found no significant difference in the rate of 5-minute APGAR score between AMA women and younger women which is in accordance with other studies [3, 10, 14, 16]. We found no significant difference in the rates of admission into NICU between babies born to women with AMA and those of younger ages. This finding is similar to that of Jeong et al. [14] but differs from that of Lean et al. [2] and Guarga et al. [16] who found that AMA was associated with increased admission into NICU. While both of those studies included preterm deliveries, our study included only term pregnancies (≥ 37 weeks gestation) which may explain the difference and offers more validity to our results.

Although many AMA women are choosing to deliver via CD, our findings may assist practitioners in conducting risk-based decision-making consultations to ensure women are making informed decisions. We found that women with AMA are not at higher risk of major postpartum complications like hemorrhage or perineal tears. Importantly, babies to AMA mothers are not at higher risk of low 5-minute APGAR score, nor admission into NICU. Providing elective CD over trial of labor in AMA women on the basis of age, does not appear to be beneficial or evidence-based.

Strengths and limitations

Our study has some limitations to consider. Retrospective cohort studies are limited in that there is little control over the data collected in the electronic patient records. Data on socioeconomic status, CD indications, time of delivery, and primary practitioner were limited. These become potential confounders that were not included in the study. Since this study covered an extensive timeframe, analyzing changes across different time periods may reveal shifts in obstetric practices that impact outcome variables. Future studies should examine how practices evolve to identify trends and influencing factors. We also had missing data for three variables including postpartum hemorrhage.

It is possible that our results may not be generalizable to the US or to other countries with a high baseline CD rate. However, the findings may still be broadly applicable and give insights into outcomes of patients with AMA. On the other hand, our study is based on a large sample size of a culturally diverse population with a high fertility rate. Further research may explore reasons for self-requested CD among AMA women and may indicate that women without obstetrical or medical contraindications should be allowed and encouraged to attempt a trial of labor and vaginal delivery based on risk.

Conclusions

AMA women in our study were more likely to deliver with CD. One reason is the high rate of self-requested CD among AMA women. We found that women with AMA are not at higher risk of major postpartum complications like hemorrhage or perineal tears. Importantly, babies to AMA mothers are not at higher risk of low 5-minute APGAR score, nor admission into NICU. Providing elective CD over trial of labor in AMA women on the basis of age, does not appear to be beneficial or evidence-based. Clinicians should thus offer women personalized care allowing women to decide on mode of delivery based on the risk to their health and that of their baby.

Data availability

The datasets used and/or analyzed during the current study are not publicly available but may be available from the corresponding author upon reasonable request.

Abbreviations

AMA:

Advanced maternal age

CD:

Cesarean delivery

NICU:

Neonatal intensive care unit

References

  1. Martin JA, Hamilton BE, Osterman MJK. Births in the United States. NCHS Data Brief No 318; 2018.

  2. Lean SC, Derricott H, Jones RL, Heazell AEP. Advanced maternal age and adverse pregnancy outcomes: a systematic review and meta-analysis. PLoS ONE. 2017;12(10):e0186287.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Shams T, Gazzaz T, Althobiti K, Alghamdi N, Bamarouf W, Almarhoumi L, et al. Comparison of pregnancy outcomes between women of advanced maternal age (≥ 35 years) versus younger women in a tertiary care center in Saudi Arabia. Ann Saudi Med. 2021;41(5):274–9.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Berkowitz GS, Skovron ML, Lapinski RH, Berkowitz RL. Delayed childbearing and the outcome of pregnancy. N Engl J Med. 1990;322(10):659–64.

    Article  CAS  PubMed  Google Scholar 

  5. Beaujouan MNB. Fertility postponement is largely due to rising educational enrolment. Popul Stud (Camb). 2012;66(3):311–27.

    Article  PubMed  Google Scholar 

  6. Molina-García L, Hidalgo-Ruiz M, Cocera-Ruíz EM, Conde-Puertas E, Delgado-Rodríguez M, Martínez-Galiano JM. The delay of motherhood: reasons, determinants, time used to achieve pregnancy, and maternal anxiety level. PLoS ONE. 2019;14(12):e0227063.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hammarberg K, Clarke VE. Reasons for delaying childbearing–a survey of women aged over 35 years seeking assisted reproductive technology. Aust Fam Physician. 2005;34(3):187–8.

    PubMed  Google Scholar 

  8. United States Census Bureau. Fertility Rates: Declined for Younger Women, Increased for Older Women 2024 [Available from: https://content.govdelivery.com/accounts/USCENSUS/bulletins/3124581#:~:text=The%20analysis%2C%20which%20looked%20at,the%20roughly%2030%2Dyear%20period

  9. Matthews TJ, Hamilton BE. First births to older women continue to rise. NCHS Data Brief. 2014;152:1–8.

    Google Scholar 

  10. Mehari MA, Maeruf H, Robles CC, Woldemariam S, Adhena T, Mulugeta M, et al. Advanced maternal age pregnancy and its adverse obstetrical and perinatal outcomes in Ayder comprehensive specialized hospital, Northern Ethiopia, 2017: a comparative cross-sectional study. BMC Pregnancy Childbirth. 2020;20(1):60.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Bayrampour H, Heaman M. Advanced maternal age and the risk of cesarean birth: a systematic review. Birth. 2010;37(3):219–26.

    Article  PubMed  Google Scholar 

  12. Gordon D, Milberg J, Daling J, Hickok D. Advanced maternal age as a risk factor for cesarean delivery. Obstet Gynecol. 1991;77(4):493–7.

    CAS  PubMed  Google Scholar 

  13. Hochler H, Lipschuetz M, Suissa-Cohen Y, Weiss A, Sela HY, Yagel S et al. The impact of advanced maternal age on pregnancy outcomes: a retrospective Multicenter Study. J Clin Med. 2023;12(17).

  14. Jeong Y, Choo SP, Yun J, Kim EH. Effect of maternal age on maternal and perinatal outcomes including cesarean delivery following induction of labor in uncomplicated elderly primigravidae. Med (Baltim). 2021;100(34):e27063.

    Article  CAS  Google Scholar 

  15. Rademaker D, Hukkelhoven C, van Pampus MG. Adverse maternal and perinatal pregnancy outcomes related to very advanced maternal age in primigravida and multigravida in the Netherlands: a population-based cohort. Acta Obstet Gynecol Scand. 2021;100(5):941–8.

    Article  CAS  PubMed  Google Scholar 

  16. Guarga Montori M, Álvarez Martínez A, Luna Álvarez C, Abadía Cuchí N, Mateo Alcalá P, Ruiz-Martínez S. Advanced maternal age and adverse pregnancy outcomes: a cohort study. Taiwan J Obstet Gynecol. 2021;60(1):119–24.

    Article  CAS  PubMed  Google Scholar 

  17. Joseph KS, Allen AC, Dodds L, Turner LA, Scott H, Liston R. The perinatal effects of delayed childbearing. Obstet Gynecol. 2005;105(6):1410–8.

    Article  CAS  PubMed  Google Scholar 

  18. Joseph KS, Young DC, Dodds L, O’Connell CM, Allen VM, Chandra S, et al. Changes in maternal characteristics and obstetric practice and recent increases in primary cesarean delivery. Obstet Gynecol. 2003;102(4):791–800.

    CAS  PubMed  Google Scholar 

  19. Rollin FB. Inference for Proportions: Comparing Two Independent Samples [Available from: https://www.stat.ubc.ca/~rollin/stats/ssize/b2.html.

  20. Souza JP, Gülmezoglu AM, Lumbiganon P, Laopaiboon M, Carroli G, Fawole B, et al. Caesarean section without medical indications is associated with an increased risk of adverse short-term maternal outcomes: the 2004–2008 WHO Global Survey on maternal and Perinatal Health. BMC Med. 2010;8(1):71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Lavecchia M, Sabbah M, Abenhaim HA. Effect of Planned Mode of Delivery in women with advanced maternal age. Matern Child Health J. 2016;20(11):2318–27.

    Article  PubMed  Google Scholar 

  22. World Health Organization. WHO statement on caesarean section rates. 2015.

  23. Cammu H, Martens G, Keirse MJ. Mothers’ level of education and childbirth interventions: a population-based study in Flanders, Northern Belgium. Birth. 2011;38(3):191–9.

    Article  PubMed  Google Scholar 

  24. Maman E, Lunenfeld E, Levy A, Vardi H, Potashnik G. Obstetric outcome of singleton pregnancies conceived by in vitro fertilization and ovulation induction compared with those conceived spontaneously. Fertil Steril. 1998;70(2):240–5.

    Article  CAS  PubMed  Google Scholar 

  25. Källén B, Finnström O, Nygren KG, Otterblad Olausson P, Wennerholm UB. In vitro fertilisation in Sweden: obstetric characteristics, maternal morbidity and mortality. BJOG. 2005;112(11):1529–35.

    Article  PubMed  Google Scholar 

  26. Minkoff HL, Berkowitz R. The myth of the precious baby. Obstet Gynecol. 2005;106(3):607–9.

    Article  PubMed  Google Scholar 

  27. Bettes BA, Coleman VH, Zinberg S, Spong CY, Portnoy B, DeVoto E, et al. Cesarean delivery on maternal request: obstetrician-gynecologists’ knowledge, perception, and practice patterns. Obstet Gynecol. 2007;109(1):57–66.

    Article  PubMed  Google Scholar 

  28. Bergholt T, Østberg B, Legarth J, Weber T. Danish obstetricians’ personal preference and general attitude to elective cesarean section on maternal request: a nation-wide postal survey. Acta Obstet Gynecol Scand. 2004;83(3):262–6.

    Article  PubMed  Google Scholar 

  29. Gillet E, Martens E, Martens G, Cammu H. Prelabour caesarean section following IVF/ICSI in older-term nulliparous women: too precious to push? J Pregnancy. 2011;2011:362518.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Zaki MN, Hibbard JU, Kominiarek MA. Contemporary labor patterns and maternal age. Obstet Gynecol. 2013;122(5):1018–24.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Greenberg MB, Cheng YW, Sullivan M, Norton ME, Hopkins LM, Caughey AB. Does length of labor vary by maternal age? Am J Obstet Gynecol. 2007;197(4):e4281–7.

    Article  Google Scholar 

  32. Papadias K, Christopoulos P, Deligeoroglu E, Vitoratos N, Makrakis E, Kaltapanidou P, et al. Maternal age and the duration of the second stage of labor. Ann N Y Acad Sci. 2006;1092(1):414–7.

    Article  CAS  PubMed  Google Scholar 

  33. Jandér C, Lyrenäs S. Third and fourth degree perineal tears. Predictor factors in a referral hospital. Acta Obstet Gynecol Scand. 2001;80(3):229–34.

    Article  PubMed  Google Scholar 

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Acknowledgements

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Funding

Dr. Mforteh received funding from the Pears Foundation for the MPH that led to this work. The funder had no specific role in the conceptualization, design, data collection, analysis, decision to publish, or preparation of the manuscript.

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Author notes

  1. Ronit Calderon-Margalit and Joshua I. Rosenbloom contributed equally to this work.

Authors and Affiliations

  1. Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

    Achuo Ascensius Ambe Mforteh & Ronit Calderon-Margalit

  2. Henrietta Szold Hadassah School of Nursing, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

    Abigail Kra-Friedman & Michal Lipschuetz

  3. Nursing Department, Jerusalem College of Technology– Machon Lev, Jerusalem, Israel

    Abigail Kra-Friedman

  4. Department of Obstetrics and Gynecology, Faculty of Medicine, Hadassah University Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel

    Gilad Karavani, Hila Hochler, Michal Lipschuetz & Joshua I. Rosenbloom

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Contributions

AAAMB, JR, and RCM contributed to study design, data acquisition, and analysis, and writing of manuscript. AKF contributed to data analysis, interpretation of the data, writing and editing the manuscript, and preparing the manuscript for submission. GD, ML, and HH contributed to data acquisition and editing the manuscript. AAMB and AKF are equal contributors. RCM and JR are equal contributors.

Corresponding author

Correspondence to Abigail Kra-Friedman.

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The authors declare no competing interests.

Ethics approval and consent to participate

Ethical clearance was obtained from the Institutional Review Board of the Hadassah Medical Organization in accordance with the Declaration of Helsinki. Names and identification numbers of patients were concealed in the extracted data set to ensure anonymity of the data. A waiver of consent from Hadassah Medical Organization’s ethical review board was obtained because our data was secondary data.

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Mforteh, A.A.A., Kra-Friedman, A., Karavani, G. et al. Maternal and neonatal outcomes at delivery in nulliparous women with advanced maternal age. BMC Pregnancy Childbirth 25, 270 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12884-025-07289-6

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  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12884-025-07289-6

Keywords

BMC Pregnancy and Childbirth

ISSN: 1471-2393

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