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Advanced maternal age and the risk of antepartum stillbirth

Diagnosis/definition: Stillbirth is defined as fetal death at 20 weeks or more. Advanced maternal age is defined as age 35 years or above at delivery.
Epidemiology/Incidence: About 15% of women giving birth in the US are 35 years or older, and 2.6% are age 40 or older. The risk of stillbirth in women age 35-39 is about 11-14/1,000 births and is 11-21/1,000 births in women 40 years and older.  Stillbirth risks in women 40 years or older are particularly increased after 38 weeks, and is similar to the stillbirth risk of women aged 25 to 29 years at 41 - 42 weeks.
Management:

  • It is currently unclear what the optimal management is for women age 35 and above to prevent stillbirth.  The argument in favor of antepartum surveillance starting at 37 weeks is that the risk of stillbirth at this gestational age is similar in frequency to other high-risk condition for which testing is routinely performed (chronic hypertension, diabetes, cholestasis, etc). However, there is insufficient evidence to confirm that antenatal testing for the sole indication of AMA reduces stillbirth or improves perinatal outcomes. The potential benefits of routine antepartum testing needs to be weighed against the potential harm of increased interventions, iatrogenic delivery, labor induction and possibly cesarean section.

Last Reaffirmed: Aug 1, 2014



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