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Advanced maternal age pregnancy

Key sources
The following summarized guidelines for the evaluation and management of advanced maternal age pregnancy are prepared by our editorial team based on guidelines from the American College of Obstetricians and Gynecologists (ACOG 2022) and the Society of Obstetricians and Gynaecologists of Canada (SOGC 2017).
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Guidelines

1.Diagnostic investigations

Fertility evaluation: as per SOGC 2017 guidelines, refer females > 35 yeast of age for infertility work-up after 6 months of trying to conceive because of the decline in fertility and the increased time to conception that occur after age 35.
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  • Screening for multiple gestations

  • Screening for genetic disorders

  • Screening for congenital anomalies

  • Prenatal fetal monitoring

2.Medical management

Prevention of preeclampsia: initiate daily low-dose aspirin for the reduction of preeclampsia in pregnant patients aged ≥ 35 years in the setting of at least one other moderate risk factor.
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3.Therapeutic procedures

Indications for delivery
Initiate delivery in well-dated pregnancies at 39 0/7-39 6/7 weeks of gestation in patients with anticipated delivery at age ≥ 40 years because of the increasing rates of neonatal morbidity and stillbirth beyond this gestational age.
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Consider counseling patients that vaginal delivery is safe and appropriate if there are no other maternal or fetal indications for Cesarean delivery. Include a discussion of the risks of Cesarean delivery, the patient's comorbidities, and the patient's preferences and goals. Recognize that advancing patient age alone is not an indication for Cesarean delivery.
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4.Patient education

Maternal counseling: as per ACOG 2022 guidelines, consider viewing pregnancy with anticipated delivery at age ≥ 35 years as a risk factor for adverse maternal, fetal, and neonatal outcomes when counseling patients and determining management plans. Provide nuanced counseling depending on specific age and comorbidities.
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More topics in this section

  • Paternal counseling