Anesthetic considerations in pregnant women at advanced maternal age

Objective: To evaluate anesthetic considerations in pregnancy for women at advanced maternal age (≥40 years). Methods: A retrospective cohort study of laboring women aged 40 years or above comparing women aged 40-44 years old with those aged ≥45 years, in a single, tertiary, university affiliated medical center. Results: Overall, 39006 women delivered in our institution during the study period, of them 376 (1%) were eligible for analysis: 278 (74%) were 40-44 years old (control group) and 98 (26%) were 45 years old and above (study group). No differences were found between the groups with regards to analgesia or anesthesia management during labor. Differences were found in obstetrical characteristics such as higher rates of primiparity, preeclampsia, need for magnesium sulphate therapy and chronic hypertension among parturients aged ≥45 years. Of note, parturients aged ≥45 years had an approximately eight-fold risk for postpartum hemorrhage. Conclusion: Anesthesia management of parturients aged 45 years and above is comparable to the management of women aged 40-44 years. However, parturients ≥45 are more susceptible to bleeding complications.