Prognostic Factors of Ovarian Cancer

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Pregnancy And Advanced Maternal Age
Presented by Dr. AHMED WALID ANWAR Murad Lecturer
of Obstetrics and Gynecology Benha Faculty of
Medicine Egypt 2008
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• Pregnancy after age of 35 years is the term that
  implies
• 1-? Fertility.
• 2-? Risk.

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Epidemiology

• In advanced countries, Total fertility rate ?from
  5 children/woman lifetime in the period 1950-1955
  to 2.5 children/woman lifetime in the period
  2000-2005.
• There is increased shift towards delayed child
  bearing.

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Shift towards delayed child bearing is due to

• Changing role of women in work more career
  opportunities are available.
• High female educational level.
• Free choice of partner.
• ? Contraceptive opportunities.
• ?Availability of ART ?Sensation of women that
  they may achieve pregnancy and childbearing at
  any time.

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Pregnancy At Advanced Maternal Age may be due to

• 1- Late marriage.
• 2- Long period of primary infertility.
• 3- Delayed childbearing.

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Woman must balance

• The biological advantages of having child birth
  at younger age.
• AGAINIST
• Economic and social advantages of having
  education and establishing career.

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Pregnancy At Advanced Maternal Age Risks And
Management.
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In such situation we deal with two issues.

• I Preconceptional issues before pregnancy.
• II Conceptional issues during pregnancy, labor
  ,and puerperium.

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I Preconceptional Issues.

• ? Maternal age ?? fertility.

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Factors responsible for? fertility.

• 1-Physiological factors
• ? Maternal age ?? ovarian reserve.
• 2-Pathological factors
• a Tubal pathology worsen by time
• b Uterine pathology? causes related to advanced
  age e.g. uterine fibroid, and endometrial
  hyperplasia.

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Advanced Maternal Age Preconceptional risks and
management.

• 1-?Risk of anueploidy in oocyte
• Def Abnormal number of chromosomes around the
  normal figure
• Causes
• Non-dysjunction
• Robertosonian translocation

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1-?Risk of anueploidy in oocyte

• Types
• A Monosomy
• Absence of one homologous chromosome.
• It is the result of anaphase lage
• Autosomal monosomy is fatal.
• B Triosomy presence of 3 homologous chromosome.
• Management
• ART with preimplantation genetic diagnosis.
  transfer only embryos with no genetic
  abnormalities.

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2- Poor response to ovulation induction

• Management of Poor ovarian responders
• Modified protocols of ovulation induction.
• Modified techniques.
• Use of natural cycle IVF.
• Use of adjutants.
• Ovum donation.

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3-?IVF success rates

• Chance of progress from beginning of ART to
  pregnancy ? with ? age.

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ConclusionOlder woman with poor ovarian reserve.

• ART Ovum donation
• Success rate No significant decline up to age of
  50 yrs then small decline in implantation rate.
• Risk of anueploidy depends on age of egg donor.
• Risk of third trimester complications ? with ?
  recipient age.

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II Conceptional issues during pregnancy.
Maternal Risks
Fetal Risks
Pregnancy
labor
Puerperium
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Fetal Hazards

• 1- Higher incidence of
• Chromosomal abnormalities. triosmy 21? 1/350
  after age of 35 yrs.
• Congenital fetal malformation.
• Spontaneous abortion.
• IUGR.
• Preterm labor with all the hazards of
  prematurity.
• Fetal asphyxia.

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Fetal Hazards

• 2- ? Perinatal mortality rate after adjusting
  confounding factors parity, maternal diseases,
  smoking, and/or congenital fetal malformation.

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Maternal Hazards

• I During pregnancy
• 1- Higher incidence of
• PIH Preeclampsia eclampsia
• spontaneous abortion and its complications.
• 2-D.M and its complications after age of 40yrs
• 3-Abnormal placentaion abruptio placentae,
  placenta praevia

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Maternal Hazards

• II During Labor
• 1-Dysfunctional labor.
• 2-Prolonged labor.
• 3-Chorioamnionitis.
• 4-Atonic PPH.
• 5-Trumatic PPH.

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Maternal Hazards

• III During Puerperium
• 1-Subinvolution of the uterus.
• 2-Purperal sepsis.
• N.B Important Notes
• Maternal Mortality? Risk ?with ?age.
• Delayed childbearing ?eliminate the protective
  effect of pregnancy against cancer ovary ,cancer
  breast.

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Management of pregnancy at Advanced maternal Age

• A Proper antenatal care.
• B Proper intra-partum care.
• C Proper management of neonate.

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A Proper antenatal care.

• Aim
• Early detection and proper treatment of any fetal
  or maternal abnormalities.

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A Proper antenatal care.

• Clinically
• Maternal examination? Good indicator.
• Screening for disorders complicating pregnancy
  e.g. P.E, or DM , and proper treatment of them.
• Fetal kick count.
• Estimation of gestational age.
• Auscultation of FHS.

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A Proper antenatal care.

• Investigations

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B Proper intra-partum care.

• Aim
• Monitoring of both fetus and mother for early
  detection of
• Dysfunctional labor.
• Fetal asphyxia.

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B Proper intra-partum care.

• I Clinically partogram ,examination of AF.
• II Electronic fetal monitoring? external or
  internal.
• III Biochemical scalp blood sampling.

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C Proper management of neonate.

• Fetal Resuscitation .
• Exclude CFMF / or chromosomal abnormalities.

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Thank you
E.MAILahwalid2004_at_yahoo.com