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Peri-partum course of a 67-year-old elderly gravida
Abstract Number: FCA-125
Abstract Type: Case Report Case Series
Background: There is limited data on the anticipated prenatal, intrapartum, and postpartum course among gravida over 45 years old, particularly among post-menopausal women in their sixth and seventh decades. Here, we present a relatively uncomplicated case of pregnancy in a 67-year-old woman conceived by donor oocyte in vitro fertilization (IVF) and was able to successfully breastfeed postpartum.
Case: A 67-year-old essential primigravidae (G5P0040) conceived a singleton pregnancy via IVF with donor oocytes in West Africa, then immigrated shortly thereafter to the US and presented at 11 1/7 weeks gestation to initiate prenatal care. Her obstetric history was significant for four second trimester losses. Her medical history was significant for chronic hypertension, hyperlipidemia, and Class I Obesity. Given marked advanced maternal age, her cardiac function was monitored throughout pregnancy with echo-cardiograms and serum markers. She otherwise received generally accepted “standard care” for elderly gravidae. She was delivered at 36 1/7 weeks of gestation by primary cesarean delivery when increased shortness of breath and physical exam findings precipitated a follow up echocardiogram which demonstrated a 6% decline in left ventricular ejection fraction with new-onset mitral regurgitation. An uneventful single shot subarachnoid block was performed to provide anesthesia along with neuraxial preservative free Morphine for post-operative analgesia. Her post -anesthetic course was uncomplicated.
Her intra-partum and post-partum course were uncomplicated, and she was able to successfully breastfeed and resume pre-pregnancy activity level within 2 weeks of delivery.
Discussion: The data for per-partum course of such elderly parturients is lacking, but this case highlights several anesthetic and obstetric concerns. A multidisciplinary approach with close follow up was essential for successful management of this patient. This case also makes one consider the ethical issues of assisted reproductive technology use in the postmenopausal women.
This case represents the eldest gravidae identified in the literature to date, and illustrates the potential for a relatively uncomplicated perinatal course including capacity for breastfeeding. This case may enable providers to counsel elderly patients on mode of delivery, anesthetic considerations, and anticipated outcomes.
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3. Cavazos-Rehg PA, Krauss MJ, Spitznagel EL, Bommarito K, Madden T, Olsen MA, et al. Maternal age and risk of labor and delivery complications. J Maternal Child Health 2015; 19(6): 1202-1211