Pregnancy Over 35 - Dr. Pelucio

Advanced Maternal Age

1. Societal impact of pregnancy in advanced maternal age
2. Risks of infertility and dangers delaying reproduction are rarely taught even at college or professional graduate level
3. Older gravidity is always associated with higher risk
4. These risks include:
   1. Miscarriage
   2. Pre-eclampsia
   3. Small for gestational age (SGA)
   4. Gestational diabetes
   5. Caesarean section
5. Advanced maternal age and IVF is NOT associated with increased risk of  ovarian or breast cancer

 
Peripartum Cardiomyopathy

1. Peri-partum Cardiomyopathy  (PPCM) is on the rise, possibly associated with increase in maternal age
2. Risk factors for PPCM include:
   1. Black race
   2. Advanced maternal age
   3. Tocolytic therapy
   4. Twin pregnancies
3. Early signs of PPCM mimic pregnancy
4. Orthopnea, persistent dyspnea, and tachypnea are not typical for normal pregnancy
5. Echocardiogram is the Gold Standard for LV systolic dysfunction
6. Treatment includes BP control, afterload reduction, diuresis, possible anticoagulation
7. Black race and indigence associated with poorer prognosis

 
Assisted Reproduction

1. IUI- intrauterine insemination after ovarian stimulation with clomiphene
2. IVF- more potent ovarian stimulation with both egg and sperm being handled outside uterus
3. Ovarian Hyperstimulation Syndrome
   1. Associated with IUI and IVF
   2. Pathophysiology is associated with increased vascular permeability mediated by hCG or LH
   3. More prolonged and severe in cycles when conception occurs
   4. Nausea, vomiting, abdominal bloating  in mild to moderate cases; significant ascites and pleural effusions  in more severe cases
4. Risk of ectopic, interstitial, cervical, and heterotopic pregnancies are increased in ART

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