Fertility in women after age forty-five.

Pregnancy after age 45 years is infrequent and the mother and baby should be considered as a high risk. There is a greater incidence of spontaneous abortion, gestational trophoblastic disease and chromosomal abnormalities in the fetus. Birth control practices should be discontinued after 49 years of age in the best interest of the woman's sexuality if abortion is acceptable to her. The patient should be completely informed of the risks and, in the event of pregnancy, abortion should be advised.

PIP: Data relating to pregnancies at age 45 years and older at Columbia Hospital for Women in Washington, D.C. during the 1967-1977 period are presented. The data were obtained from the individual medical records of 72,005 pregnant women selected on review of computerized summary reports of the annual admissions of private and staff obstetrical patients to the hospital. 105 charts of private patients 48-55 years were reviewed in relation to pregnancy and menstrual abnormalities. On the basis of age and obstetrical history, the patients were selected for inclusion in this study. They were contrasted according to age, gravidity, parity, abortions, outcome of pregnancy, complications, and birth control practices. There were 10 patients who menstruated to age 55 with an occasional missed period, 63 patients menstruated regularly to age 50, and the remainder had irregular menses before complete cessation of menstruation. None of these patients after age 49 years used contraception or hormone replacement therapy. 25 of this group had endometrial biopsies as an office procedure or hospital dilatation and curettage for irregular bleeding. 8 of the 25 demonstrated secretory endometrium with evidence of ovulation. There were no pregnancies in this group of women. There were 82 pregnancies that occurred in women 45 years of age and older. The oldest in this group delivered 6 days after her 49th birthday and 1 week beyond her expected date of confinement. This was her 10th pregnancy. There were 24,779 abortions in the study period. The total number of induced abortions during the period was 17,869 with 31 patients 45-51 years of age. There were 4 patients 48-49 years of age and 1 patient 51 years. The data collected reconfirm that pregnancies in older women are infrequent and must be considered as high risk. The gynecologist should counsel the patient realistically as to her chances of becoming pregnant after age 48. The risk of pregnancy in the older woman relative to the risk of various birth control practices must be carefully weighed.

Surgical and obstetrical complications of intrauterine devices in a specialty hospital.

PIP: A 3 year study (January 1964-October 1967) of 3250 intrauterine insertions and complications at Columbia Hospital was made. 422 devices were removed due to abnormal bleeding (7 requiring hospital admission). 1 Birnberg Bow user required hysterectomy to control bleeding. 36 removals were due to inflammatory disease; 22 removals were cramping; 2 involved perforations of the uterus; and 2 pregnancies with device in situ resulted. Intrauterine devices are effective contraceptives and these severe cases should be weighted against protection afforded the balance of users.^ieng