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Cesarean Delivery of Premature Triplets to 56 year old Surrogate Mother
Abstract Number: 42
Abstract Type: Case Report/Case Series
Over the past decade, there has been a steady increase in the number of women having babies who are over the age of forty. With advanced maternal age, there is often an increase in pre-existing comorbidities such as cardiovascular disease, pulmonary disease, diabetes and obesity. However, advanced maternal age is itself also an independent risk factor for perinatal complications. In addition, the use of assisted reproductive technology often leads to multiple gestations which are also associated with increased maternal and neonatal morbidity.
We present a 56 year old G5P4 postmenopausal woman status post in vitro fertilization who was admitted at 30 weeks gestation for cesarean delivery of dichorionic triplets secondary to intrauterine growth retardation. She was a recent ex-smoker with a past medical history significant for osteopenia, a cesarean with her last pregnancy over 25 years earlier, and no history of complications from anesthesia.
During her pregnancy, she experienced transient bleeding at the beginning of her second trimester which resolved, a transient rash and blurry vision, and increasing bilateral lower extremity non-pitting edema. Her workup, however, was negative for gestational diabetes and pre-eclampsia. She had a Shirodikar cerclage placed at 12 weeks gestation without any complications.
We performed a spinal anesthetic for the cesarean delivery. Her blood pressure remained stable throughout the delivery with noninvasive pressures ranging 110-130/65-75; she did not require any vasopressors and all three babies were delivered successfully. The patient did well postoperatively and was discharged POD 4. Her only postoperative complication was wound dehiscence requiring surgical repair weeks later. All three neonates were maintained in the NICU for five weeks and then discharged home.
Although many studies agree that advanced maternal age is an independent risk factor for placental abruption, gestational diabetes, pregnancy-induced hypertension and cesarean section, a few studies have shown improved outcomes in triplet pregnancies to women over 40 years old. One proposed hypothesis for this apparent paradox is that women using assisted reproductive technology are more financially secure, receive better prenatal healthcare, and are healthier prior to conception, and therefore, have less eventful pregnancies and deliveries. Since our patient was relatively healthy and had minimal maternal complications during her pregnancy, we treated her much the same as we would any other healthy, younger patient without any adverse consequences.