title: [Mode of conception, acompanying medical disorders and complications in the second half of pregnancy in women over the age of 35].
abstract: OBJECTIVE
  To assess the impact of maternal age on the mode of conception, the incidence of accompanying medical disorders and past surgical procedures (gynecological and non-gynecological) and the complications in the second half of pregnancy (preeclampsia, placenta praevia, placental abruption, preterm delivery) in women ≥ 35 years, followed prospectively.
  
  
  METHODS
  Between 02/2012 - 02/2014 495 pregnant women of ≥ 12 weeks of gestation were enrolled in the study. The patients were admitted for different indications at the Fetal Medicine Clinic of the State University Hospital "Maichin Dom". They were divided in 3 age groups according to age: ≤ 34, 35-39 and ≥ 40 years. The information about pregnancy course and outcome was retrieved from the hospital records or obtained from the patents themselves by phone interviews. The following complications in the second half of pregnancy were analyzed: preeclampsia, placenta praevia, placental abruption, preterm delivery. The data were processed with SPSS 13.0. statistical package. Descriptive and comparative analysis was performed after grouping according to one or more characteristics; p values < 0.05 were considered as evidence of statistical significance for tested effects.
  
  
  RESULTS
  The number of patients ≤ 34 years of age was 131/495 (26.5%), between 35-39 years--54/495 (51,.%) and >≥40 years --10/495 (22,.%). Conception by ART was significantly more frequent in women aged >3 5. Pregnancy occurred afterA RTi n 1,.% (2/131) of the women <3 4, in 8,.% (22/254) of those between 35-39 and in 10,.% (12/110) of those >≥ 0 years of age (p= O 0.08). The incidence of accompanying medical disorders (intemrnl, tumors, of the female genital system) was significantly higher in women of more advanced age (p< O 0.01). It was 36,.% (48/131) in those <3 4, 53,1% (135/254) --n the ones between 35-39 and 68,.% (75/110) --mong those >≥ 0 years of age. The increased incidence was mainly due to more frequent intemrnl (p= 0 ,.218) and female reproductive system (p=0,0027) disorders. The incidence of past surgical procedures was increased significantly with advancing maternal age; this was attributed mainly to non-gynecological surgical procedures (p= O 0.04). Among women <3 4 years 41,.% (54/131) reported past surgery, while in the age groups between 35-39 and >≥ 0 years the figures were 57,.% (146/254) and 59, 1% (65/110) respectively .The increase of maternal age was related to significantly more frequent complications in the second half of pregnancy --reeclampsia, placenta praevia, placental abruption and preterm delivery. The incidence of preeclampsia increased from 1,.3% (2/131) in the age group <3 4, to 3,.3% (10/254) for those aged 35-39 and to 7,.7% (8/110) --or the ones _≥ 0 (p= O 0.5). The combined incidence of placenta praevia and placental abruption was also significantly higher in women of more advanced age (p= 0 ,.056). In the age group <3 4 no such cases were registered while in women aged 35-39 the incidence of these complications was 3, 14% (8/254) and for the age group >≥ 0 it was 8,.8% (9/110). The combined incidence of placenta previa and placental abruption was considered because of the small number of cases. The complications cited above were significantly more frequent in women with accompanying medical disorders (p = 0,001). The incidence of preterm deliveries increased significantly with maternal age --rom 10,.% (14/131) for women <3 4 to 25,.% (52/208) --or those between 35-39 and 21,.% (20/93) --or those _≥ 0 years of age (p= 0 ,.13). The combined preterm delivery rate was considered in the study (spontaneous and induced).
  
  
  CONCLUSIONS
  In our study maternal age >≥ 5 years was related to significantly more frequent conception by ART history of accompanying medical disorders, past surgery (non-gynecological) and complications in the second half of pregnancy (preeclampsia, placenta praevia, placental abruption and preterm delivery).
authors: T
authors: T
authors: Dakov
authors: V
authors: V
authors: Dimitrova
authors: A
authors: A
authors: Maseva
authors: T
authors: T
authors: Todorov
mesh_terms: D000037:Abruptio Placentae / Q000453:epidemiology*; D000328:Adult; D002031:Bulgaria / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008423:Maternal Age; D010923:Placenta Previa / Q000453:epidemiology*; D011225:Pre-Eclampsia / Q000453:epidemiology*; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology*; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects; D012307:Risk Factors