Ilse Delbaere

Perinatal outcome of twin pregnancies in women of advanced age

BACKGROUNDnThe aim of this study was to assess the outcome of twin pregnancies in women of advanced age (>or=35 years) compared with women aged 25-29 years old.nnnMETHODSnThis population-based retrospective study compared perinatal outcome of twin pregnancies in primiparae aged 35 or older (N = 240) to that of twin pregnancies in primiparae aged 25-29 years (N = 940). Observed outcomes are adjusted for intermediate (mode of conception and hypertension during pregnancy) and confounding variables (level of education). The possible effect of zygosity and chorionicity was tested in a subset of this database, recorded in the East Flanders Prospective Twin Survey (EFPTS).nnnRESULTSnIn twin pregnancies, maternal age of 35 or over is associated with a lower incidence of preterm birth [adjusted odds ratio (AOR) 0.59, 95% confidence interval (CI) 0.44-0.79] and low birthweight (AOR 0.75, 95% CI 0.58-0.98) compared with younger women. Differences in zygosity and chorionicity between both cohorts do not seem to affect the result.nnnCONCLUSIONSnIn comparison with primiparae aged 25-29 years, perinatal outcome of twin pregnancies is more favourable in primiparae aged 35 or over.

Limiting the caesarean section rate in low risk pregnancies is key to lowering the trend of increased abdominal deliveries: an observational study

BackgroundAs the rate of Caesarean sections (CS) continues to rise in Western countries, it is important to analyze the reasons for this trend and to unravel the underlying motives to perform CS. This research aims to assess the incidence and trend of CS in a population-based birth register in order to identify patient groups with an increasing risk for CS.MethodsData from the Flemish birth register Study Centre for Perinatal Epidemiology (SPE) were used for this historic control comparison. Caesarean sections (CS) from the year 2000 (N = 10540) were compared with those from the year 2008 (N = 14016). By means of the Robson classification, births by Caesarean section were ordered in 10 groups according to mother - and delivery characteristics.ResultsOver a period of eight years, the CS rise is most prominent in women with previous sections and in nulliparous women with a term cephalic in spontaneous labor. The proportion of inductions of labor decreases in favor of elective CS, while the ongoing inductions of labor more often end in non-elective CS.ConclusionsIn order to turn back the current CS trend, we should focus on low-risk primiparae. Avoiding unnecessary abdominal deliveries in this group will also have a long-term effect, in that the number of repeat CS will be reduced in the future. For the purpose of self-evaluation, peer discussion on the necessity of CS, as well as accurate registration of the main indication for CS are recommended.