Pregnancy and the older woman
FERTILITY generally begins to decline when a woman is in her mid-30s, and declines rapidly after her late 30s. And while technology has given hope to women who find themselves desiring motherhood in their middle years, there are various pre-natal, birthing and post-natal complications that these women are at a greater risk of experiencing.
“The patient who has an advanced maternal age is age 35 and older. Women who are in their late 30s and older who are pregnant have a higher risk of many complications. These include a higher risk of miscarriage and premature births. These may be linked to a higher risk of birth defects [as well as] risks of genetic anomalies such as Down’s Syndrome,” Dr Keisha Buchanan, obstetrician-gynaecologist at Icon Medical Centre, explained.
She said the complications vary from woman to woman depending on a number of factors generally related to lifestyle and health at the time of getting pregnant. This, however, is not always the case.
“Women of advanced maternal age are at risk of high blood pressure problems and preeclampsia, which is high blood pressure with protein in the urine, gestational diabetes and [aggravating] pre-existing diabetes. These [conditions] increase the chances of hospitalisation and early delivery. However, a healthy lifestyle and weight before pregnancy will help to prevent these conditions from developing and increase the chances of a favourable pregnancy outcome,” Dr Buchanan said.
She pointed out that modern technologies help to manage the increased complications associated with pregnancy in older women, noting that not only the mothers, but the foetuses as well, can be monitored more closely, even during labour.
“Thanks to new technological advancements, foetal health can be detected earlier now. From as early as just three months, a new test called the Harmony test gives a strong indication of whether the foetus is at high or low risk of having Down’s Syndrome, Edwards’ Syndrome or Patau Syndrome. Prior to that women would have to wait four months or later to have other tests done and some of these tests were less accurate,” Dr Buchanan said.
She indicated that another piece of technology that has proved very important to older women is the high-resolution 4D ultrasound which can identify structural birth defects such as that of the heart more readily.
She also noted that there is a wider range of medication primarily designed to prevent premature labour. While these medications aid in encouraging a longer time in the womb for the foetus at a greater risk of premature birth, sometimes, especially in the absence of these medications, mothers end up in labour much sooner than anticipated. Dr Buchanan said nowadays, with advanced neonatal care, even babies that are born as early as 26 weeks have a much-improved chance of survival in the Neonatal Intensive Care Unit.
Dr Buchanan told All Woman that the birthing process overall has improved for women with the inclusion of technology.
“Vaginal delivery is still going to be the ideal route of delivery, but it is not the best route in all cases. However, the Caesarean section rate is higher in older women and fortunately, if this needs to be done, it is readily available in hospitals all across the island to ensure a safer delivery of the baby.”
She said that in the event of post-partum haemorrhaging [heavy bleeding] which features heavily in older women, Carbetocin, a new drug used in the prevention and treatment of the life-threatening condition, has proven very effective.
She said another notable technology important to the birthing process is the ability to now monitor the foetus in labour. Dr Buchanan explained that it is now more likely for health care professionals to determine if a problem such as foetal distress is arising, so that medical intervention to prevent any possible harm to the baby can be provided immediately.
