title: The impact of antenatal testing for advanced maternal age on cesarean delivery rate at an urban institution.
abstract: OBJECTIVE
  Antenatal testing has been implemented for advanced maternal age (AMA) women given their increased stillbirth risk. Our objective was to evaluate cesarean delivery and induction rates after the start of antenatal testing at our institution.
  
  
  METHODS
  A retrospective cohort study of AMA women (≥ 40 years) who delivered at our institution was performed. Testing for AMA began in 2005. AMA women who delivered before (unexposed) and after (exposed) the implementation were compared. Our primary outcome was cesarean delivery and secondary outcome was induction. Chi-square compared categorical variables and multivariable logistic regression calculated odds ratio (OR) and controlled for confounders.
  
  
  RESULTS
  A total of 276 women were included (147 unexposed and 129 exposed). The cesarean rate was higher in the exposed group (53 vs. 39%, OR 1.76 [1.09-2.84]). The increased risk of cesarean remained after adjusting for race, previous cesarean, multiple gestations, and parity (adjusted OR 1.85 [1.05-3.28]). When excluding those with previous cesareans, the risk of primary cesarean was not significant (OR 1.57 [0.89-2.76]). The induction rate was not different (38 vs. 33%, p = 0.4).
  
  
  CONCLUSIONS
  While overall cesareans increased, there was no difference in primary cesarean and induction rates for AMA women after implementation of antenatal testing for AMA.
authors.affiliation: Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Lisa D
authors.initials: LD
authors.lastname: Levine
authors.affiliation: Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Sindhu K
authors.initials: SK
authors.lastname: Srinivas
authors.affiliation: Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Paré
authors.affiliation: Department of Obstetrics and Gynecology, New York University School of Medicine, Maternal Fetal Care Center, New York, New York.
authors.forename: Shilpi S
authors.initials: SS
authors.lastname: Mehta-Lee
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D005323:Fetal Monitoring / Q000379:methods*; D006786:Hospitals, Urban; D006801:Humans; D007751:Labor, Induced / Q000706:statistics & numerical data*; D016015:Logistic Models; D008423:Maternal Age; D015999:Multivariate Analysis; D010298:Parity; D011247:Pregnancy; D011272:Pregnancy, Multiple / Q000706:statistics & numerical data*; D011295:Prenatal Care / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors