Abstract

Pregnancy and childbirth are normal physiological processes and the maternal and neonatal outcomes of most of the pregnancies are good. In India, women of childbearing age consist of 19% of the population. Data suggests that approximately 40% of all women develop some kind of complication.¹ One of the risk factors for such complication is elderly pregnancy, which leads to many complications during pregnancy, labor and also for the baby. Advanced maternal age is usually considered to signify age after 35 years at the time of delivery. It is the term which implies reduced fertility as well as raised risk.² A significant number of women are choosing to postpone their pregnancy well late beyond the third decade of life, even into the fourth and fifth decades in few cases.³The reason for delayed pregnancy could be classified in to those in urban regions and those in rural areas. Changes in the structure of family with more late marriages or remarriages, women’s chase of higher education, career advancement, and advances in assisted reproductive technique along with availability of effective and safe contraceptives are urban reasons, while the cultural reasons and illiteracy being the main causes in rural areas.^3,4
Pregnancy after the age of 35 years can be challenging due to the maternal and fetal risk involved. Chronic hypertension, diabetes mellitus, miscarriage, subfertility, ectopic pregnancy, antepartum hemorrhage, anemia, malpresentation, postpartum hemorrhage all lead to augmented incidence of instrumental deliveries as well as cesarean sections. Fetal along with neonatal risk is also augmented because of raised incidence of chromosomal abnormalities (mainly Down's syndrome), IUGR, multiple pregnancy, prematurity leading to greater number of NICU admission. Perinatal morbidity as well as mortality is raised in these pregnant women.⁵ Hence, it is not wrong to say that advanced maternal age is related with poor maternal and fetal outcomes according to scientific evidence published. 
An extensive literature search revealed that though there is a plethora of evidence from western countries with regards to the maternal and fetal outcomes of advanced maternal age, such scientific data from India is scarce. There is a definitive increase expected in the number of women in this group, both in developed and developing countries, thus necessitating an in-depth review, and updating of knowledge in the management of this category of women. Hence, this study was conducted to evaluate the maternal and perinatal outcomes of pregnancies in advanced maternal age.