노령산모의 최근 임신 및 출산추세에 관한 연구 = A Clinical Study on the Recent Tendency of Pregnancy and Delivery in Eldery Gravida

다국어 초록 (Multilingual Abstract)

We have compared the obstetric performances of elderly gravida with those of young gravida and assessed the recent tendency of pregnancy and delivery in elderly gravida. The data presented are based on 421 cases of mothers with advanced age, 35 years or more among a total of 9351 deliveries ween in Ewha Womans University Hospital in the past 4 years. (from 1991 to 1994). As the control subject 309 cases of age less 35 years were randomly selected from the repective period. The results were as follows. 1. The rate of elderly gravida was increased from 2.0% in 1991 to 6.1% in 1994. 2. The age distrivution of elderly gravida was from 35 years to 45 years. 3. The parity of elderly gravida was that primigravida was 22.8% and mulitgravida was 77.2%. 4. Vertex presentation was seen in 383 cases(91.0%), breech presentation in 35 cases(8.3%), and transeverse lie in 3 cases(0.7%). The frequency of abnormal presentation was significantly higher in the elderly gravida group than control group. 5. The preterm pregnancy was seen in 6.9% compared with 7.8% in control group. The postterm pregnancy was observed in 1.4% compared with 3.6% in control group. 6. In the elderly gravida, the rate of casarean section was ween in 58.2% compared with 35.6% in control group. Among the reasons for cesarean section, the highest incidence was previous C/S(54.3%). Other indications were elderly primigravida, CPD and abnormal presentation in decreasing order. 7. Concerning the prenatal complication, the incidence the hypertesive disorder was seen in 5.9% compared with 4.5% in control group. 8. Incidence of low birth weight (4,000 gm) was 13.1%, compared with 1.9% in control group. The rates of low apgar score, perinatal mortality, neonatal death and congenital anomaly were not significantly different from control group. 9. The male-to-female sex ratio was 1.25: 1, compared with 1: 1.9 in control group. The delivery rate of male baby was significantly higher in the elderly group than in control group. In conclusion, cesarean section rate is increased because doctors prefer cesarean section for elderly primigravida. So, if operation is performed only in selected patients who have the proper indicatins, we can decrease the rate of cesarean section. Prenatal complications and perinatal mortality rate show no significant differences between elderly gravida and younger gravida. Thus, provided that careful antenatal and intrapartal care is taken for elderly gravida, women have no reason to fear delayed childbirth. Since artificial abortion adversely affects maternal health and disproportionately high male-to-female sex ratio is expected to cause numerous social problems in the future, sex determination and artificial abortion by educating the patients to abandon the idea of preferential of male baby must be prevented.