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Incidence and risks of caesarean section in women aged ≥ 40 years

Monia Puglia

In recent decades, there has been a tendency for women in developed countries to postpone their reproductive plans to an older age. The advanced maternal age is characterized by a greater risk of complications of maternal pregnancy such as hypertension, diabetes, and placental problems. Mothers over 40 have significantly higher risks of caesarean section. The aim of this study is to evaluate the phenomenon of childbirth in women over 40 in Tuscany and to describe the reasons for caesarean sections in this population. The data sources used were the Childbirth Assistance Certificate (Cedap) and the Nosological Card (SDO). Logistic models (adjusted for parity, ART and BMI) were carried out for the maternal age risk factor. Caesarean section is performed more frequently in women aged 40 and over: 39.4% at 40-42 years, 58.2% at 43 and more (25.4% in women under 40), both in single and in multiple pregnancies. The caesarean section rate increases significantly with age. Multivariate analysis confirmed that women older than 40 years have a higher risk of a caesarean section due to pathologies such as diabetes or eclampsia which are clearly more frequent in these categories of women. Furthermore, the data shows that the caesarean section in some cases was carried out due solely to the age of a primiparous woman. The phenomenon affects health services and social costs and should make us reflect upon the underlying reasons that bring women to delay their reproductive project and where necessary implement appropriate political strategies.