Obstetric outcome in elderly nulliparous women: a comparative study


  • Sajeethakumari Raveendran Department of Obstetrics and Gynecology, S.R.M. Medical College Hospital and Research Centre, Kanchipuram, Tamilnadu, India
  • Swarnalatha Mohanapu Department of Obstetrics and Gynecology, S.R.M. Medical College Hospital and Research Centre, Kanchipuram, Tamilnadu, India
  • Yogashalaini Murugaiah Department of Obstetrics and Gynecology, S.R.M. Medical College Hospital and Research Centre, Kanchipuram, Tamilnadu, India




Elderly, Nulliparous, Obstetric outcome, Pregnancy complications


Background: Maternal age is an important determinant of pregnancy outcome and women aged 35 years and above delivering their first child are considered as at risk obstetric patients. The objective of this study was to determine and compare the obstetric outcome in nulliparous women 35 years and above with nulliparous women of age between 20 and 29 years of age and to compare the gestational age, birth weight, Apgar score and neonatal outcome in the two groups.

Methods: It was a retrospective study done in a tertiary care hospital in South India. 192 elderly nulliparous women more than 35 years of age who delivered at this hospital during the study period were taken as study group and nulliparous women aged 20-29 years recorded next serially in the parturient register were taken as control. Selected maternal and perinatal sociodemographic factors and other outcome variables were extracted. The data were entered into a personal computer and analyzed.

Results: Preeclampsia, GDM, fibroid complicating pregnancy, abruption, caesarean section rates (both elective and emergency), low birth weight babies and anomalous babies were significantly higher in elderly nulliparous women than the younger nulliparous controls. There was no significant difference in other maternal and perinatal outcome measures.

Conclusions: The elderly nulliparous women are at increased risk of pregnancy complications. Hence, these patients require careful management in a multidisciplinary tertiary care hospital.


Knudsen UB, Haansen V, Juul S, Secher NJ. Prognosis of a new pregnancy following previous spontaneous abortions. European J Obstet Gynec Repro Biol. 1991;39:31-6.

Clifford K, Rai R, Regan L. Future pregnancy outcome in unexplained recurrent miscarriage. Hum Reprod. 1997;12:387-9.

Bell JS, Campbell DM, Graham WJ, Penney GC, Ryan M, Hall MH. Do obstetric complications explain high caesarean section rates among women over 30? A retrospective analysis. British Med J. 2001;322(7291):894-5.

Ziadeh S. Maternal and perinatal outcome in nulliparous women aged 35 and older. Gynecol Obstet Invest. 2002;54:6-10.

Mehdi M, Naseem A. Obstetrical risks on the older primigravidas. Journal of the College of Physicians and Surgeons Pakistan. 2004;14:5.

Suwarnath C, Pinijaroen S. Pregnancy outcome in elderly primigravidas in Songlanagarind Hospital. Songkla Med J. 1998;16(2):57-63.

Joseph KS, Allen AC, Dodds L, Turner LA, Scott H, Liston R. The Perinatal Effects of Delayed Childbearing. Obstet Gynecol. 2005;105:1410-8.

Oboro VO, Dare FO. Pregnancy outcome in nulliparous women aged 35 or older. West Afr J Med. 2006;25(1):65-8.

Al THA, Abu HAT, Alsibai MH. The outcome of pregnancy in elderly primigravidas. Saudi Med J. 2003;2(11):1230-3.

Nelson. Risk of hypertension as age advances. Br J Obstet Gynecol. 1995;23:169.

Pandit S, Kale D. Obstetris outcome in elderly primigravida…How did they fare? Bombay Hospital Journal. 2011;53(4):715-20.

Gharoro EP, Igbafe AA. Maternal age at first birth and obstetric outcome. Nigerian J Clinical Practice.2002;5(1):20-4.

Babrowski R, Bottoms SF. Under appreciated kisks of elderly nullipara. Am J Obstet Gynecol. 1995;172(6):1764.

Ananth CV, Savitz DA, Watson A, Luther R. Influence of hypertensive disorders and cigarette smoking on placental abruption and uterine bleeding during pregnancy. Br J Obstet Gynecol. 1997;104:572.

Cnattinguis S, Forman MR, Berendes HW, Isotalo L. Delayed child bearing and risk of adverse perinatal outcome. J Am Med Asso. 1992;268:886.

Jahan MK, Shafiquzzaman M, Nahar K, Rahman M, Sultana N, Rahman MM, et al. Outcome of pregnancy in women 35 years of age and above. Mymensingh Med J. 2009;18(1):7-12.

Prysak M, Lorenz RP, Kisly A. Pregnancy outcome in nulliparous women 35 years and older. Am J Obstet Gynecol. 1994;85:65.

Allahabadia G, Vaidya P, Ambiya VR. Ind Medic Assoc. 1994;92(5):144.

Nagarwal K, Chandrakanta, Gaur K, Manohar RK. Pregnancy outcome comparison in elderly and non-elderly primigravida. International Multispeciality Journal Health. 2015;1(1):24-30.

Naqvi MM, Naseem A. Obstetrical risks in the older primigravida. J Coll Physicians Surg Pak. 2004;14(5):278-81.

Smit Y, Scherjon SA, Knuist M, Treffers PE. Obstetric outcome of elderly low risk nulliparae. Int J Gynecol Obstet. 1998;63(1):7-14.

Adashek JA, Peaceman AM, Lopez J, Minogue JP, Socol ML. Factors contributing to the increased caesarean birth rate in older parturient women. Am J Obstet Gynecol. 1993;169:963.

Ramachandran N, Sethuraman D, Nachimuthu V, Natarajan T. Obstetric and perinatal outcome of elderly mothers aged 35 years and above: a comparative study. Int J Res Med Sci. 2015;3(1):214-9.

Tsu VD. Postpartum haemorrhage in Zimbabwe: A risk factor analysis. Br J Obstet Gynecol. 1993;100:327-33.

Simpson L. Fertility after 35, Fall 2004 issue of Urban Baby and Toddler Magazine. 2004.

Astolfi D, Pasquale A, Zono LA. Late child bearing and its impact on adverse pregnancy outcome: stillbirth, preterm delivery and low birth weight. Rev Epidemiol sante Publique.2005;53:97-105.

Ling H, Sauve R, Nicholas B, Fergusson D, Carl VW. Maternal age and risk of stillbirth - a systematic review. Canadian Med Asso J.2008;178(2):165-72.

Ojule JD, Ibe VC, Fiebai PO. Pregnancy outcome in elderly primigravidae. Ann Afr Med. 2011;10:204-8.






Original Research Articles