title: Effect of Planned Mode of Delivery in Women with Advanced Maternal Age.
abstract: The purpose of this study was to determine the prognostic value of planned primary elective cesarean section versus planned vaginal delivery in women with advanced maternal age.
  
  
  
  We conducted a population-based, retrospective cohort study using the United States' Health Care Cost and Utilization Project's Nationwide Inpatient Sample to evaluate maternal outcomes in women with advanced maternal age delivering from 2003 to 2012. Healthy women who underwent primary elective cesarean section constituted a surrogate for low-risk planned cesarean delivery. Logistic regression was used to compare outcomes between women with planned cesarean and planned vaginal delivery.
  
  
  
  Among seven million births, we identified 442,067 deliveries in healthy women with advanced maternal age. The planned cesarean group comprised 7.96 % of women in the cohort. When compared to healthy women in the planned vaginal group, women in the planned cesarean group had a significantly higher mortality ratio (2.56/10,000 vs. 0.44/10,000, p < 0.01). The planned cesarean group was also at higher odds of numerous complications, including peripartum hysterectomy OR 1.81 (1.36-2.40), p < 0.01, cardiac arrest OR 5.39 (4.54-6.38), p < 0.01, acute renal failure OR 3.39 (1.78-6.46), p < 0.01 and sepsis OR 2.27 (1.25-4.14), p < 0.01.
  
  
  
  Planned cesarean section is a key factor significantly influencing maternal morbidity and mortality in healthy women with advanced maternal age. When possible, planned cesarean deliveries should be avoided in this population.
authors.affiliation: Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Pav H, Room 325. 5790 Cote-Des-Neiges Road, Montreal, QC, H3S 1Y9, Canada.
authors.forename: Melissa
authors.initials: M
authors.lastname: Lavecchia
authors.affiliation: Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Pav H, Room 325. 5790 Cote-Des-Neiges Road, Montreal, QC, H3S 1Y9, Canada.
authors.forename: Melanie
authors.initials: M
authors.lastname: Sabbah
authors.affiliation: Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Pav H, Room 325. 5790 Cote-Des-Neiges Road, Montreal, QC, H3S 1Y9, Canada. haim.abenhaim@gmail.com.|Center for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada. haim.abenhaim@gmail.com.
authors.forename: Haim A
authors.initials: HA
authors.lastname: Abenhaim
mesh_terms: D000328:Adult; D002585:Cesarean Section; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods*; D017558:Elective Surgical Procedures; D005260:Female; D005865:Gestational Age; D006801:Humans; D008423:Maternal Age; D008875:Middle Aged; D007744:Obstetric Labor Complications / Q000209:etiology*; D011159:Population Surveillance; D011247:Pregnancy; D011256:Pregnancy Outcome; D012959:Socioeconomic Factors
keywords: Cesarean section; Elective surgical procedures; Maternal age; Maternal mortality; Obstetric labor complications