Pregnancy outcome in medically complicated and uncomplicated patients aged 40 years or older.

Patients (183) who were delivered at age greater than or equal to 40 years were studied to ascertain the nature and frequency of maternal and fetal complications at a single institution in a recent time period. These patients were further grouped into those of low parity, those who began pregnancy without underlying disease, and those who began pregnancy with underlying medical disorders. For the entire group preeclampsia, premature labor, precipitate labor, and malpresentation were significantly more common. The rate of vaginal delivery was substantially decreased, and serious postpartum morbidity was relatively common. The incidence of stillbirth, perinatal mortality, and abnormal birth weight was significantly increased. There were some differences in the nature and frequency of complications encountered among the subgroups, but no subgroup had a complication rate comparable to our general obstetric population.

The epidemiology and pathology of maternal mortality: Charity Hospital of Louisiana in New Orleans, 1965-1984.

Eighty-nine maternal deaths occurred at Charity Hospital of New Orleans between 1965 and 1984, for an overall rate of 60.8 per 100,000 live births. The mortality rate increased with increasing maternal age, was greater with cesarean than vaginal delivery, and has not continued to decline over the 20-year interval. Of those decedents delivered abdominally, more than half of the deaths were attributable to operative complications, including anesthesia, rather than to an underlying disease. Although the majority of obstetric deaths were attributable to complications of hypertension, hemorrhage, and infection, the single most common cause at autopsy was pulmonary edema. Potentially preventable pulmonary edema was responsible for one-third of the obstetric deaths from hypertension and hemorrhage.