Nathan S Fox1, Andrei Rebarber, Michael Silverstein, Ashley S Roman, Chad K Klauser, Daniel H Saltzman. 1. Department of Obstetrics, Gynecology, and Reproductive Science, Mount Sinai School of Medicine, USA; Maternal Fetal Medicine Associates, PLLC, Carnegie Imaging for Women, PLLC, USA; Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA. Electronic address: nfox@mfmnyc.com.
Abstract
OBJECTIVE: To estimate the effectiveness of antepartum surveillance and delivery at 41 weeks in reducing the risk of stillbirth in advanced maternal age (AMA) patients. STUDY DESIGN: Retrospective cohort study of all patients managed in one maternal-fetal medicine practice from June 2005 to May 2012. We included all singleton pregnancies delivered at ≥ 20 weeks of gestation. All AMA patients (age ≥ 35 years at their estimated delivery date) underwent weekly biophysical profile testing beginning at 36 weeks, as well as planned delivery at 41 weeks, or sooner if indicated. We compared the rate of fetal death at ≥ 20 weeks and fetal death at ≥ 36 weeks in AMA vs. non-AMA patients. Fetal deaths due to lethal and chromosomal abnormalities were excluded. RESULTS: 4469 patients met the inclusion criteria: 1541 (34.5%) were AMA and 2928 (65.5%) were non-AMA. Using our AMA protocol for surveillance and timing of delivery, the incidence of stillbirth was similar to the non-AMA population (stillbirth ≥ 20 weeks: 3.9 per 1000 vs. 3.4 per 1000, p=0.799; stillbirth ≥ 36 weeks: 1.4 per 1000 vs. 1.1 per 1000, p=0.773). When looking at women age <35, age 35-39, and age ≥ 40, the incidence of stillbirth ≥ 20 weeks and ≥ 36 weeks did not increase across the three groups. Our findings were similar when we excluded all patients with other indications for antepartum surveillance. CONCLUSIONS: In AMA patients, antepartum surveillance and delivery at 41 weeks appears to reduce the risk of stillbirth to that of the non-AMA population. Routine antepartum surveillance should be considered in all AMA patients.
OBJECTIVE: To estimate the effectiveness of antepartum surveillance and delivery at 41 weeks in reducing the risk of stillbirth in advanced maternal age (AMA) patients. STUDY DESIGN: Retrospective cohort study of all patients managed in one maternal-fetal medicine practice from June 2005 to May 2012. We included all singleton pregnancies delivered at ≥ 20 weeks of gestation. All AMA patients (age ≥ 35 years at their estimated delivery date) underwent weekly biophysical profile testing beginning at 36 weeks, as well as planned delivery at 41 weeks, or sooner if indicated. We compared the rate of fetal death at ≥ 20 weeks and fetal death at ≥ 36 weeks in AMA vs. non-AMA patients. Fetal deaths due to lethal and chromosomal abnormalities were excluded. RESULTS: 4469 patients met the inclusion criteria: 1541 (34.5%) were AMA and 2928 (65.5%) were non-AMA. Using our AMA protocol for surveillance and timing of delivery, the incidence of stillbirth was similar to the non-AMA population (stillbirth ≥ 20 weeks: 3.9 per 1000 vs. 3.4 per 1000, p=0.799; stillbirth ≥ 36 weeks: 1.4 per 1000 vs. 1.1 per 1000, p=0.773). When looking at women age <35, age 35-39, and age ≥ 40, the incidence of stillbirth ≥ 20 weeks and ≥ 36 weeks did not increase across the three groups. Our findings were similar when we excluded all patients with other indications for antepartum surveillance. CONCLUSIONS: In AMA patients, antepartum surveillance and delivery at 41 weeks appears to reduce the risk of stillbirth to that of the non-AMA population. Routine antepartum surveillance should be considered in all AMA patients.