Predicting vaginal delivery in pregnant women of 45 years and older

Introduction: Vaginal delivery (VD) can be successfully and safely achieved in women with very and extremely advanced age. We aim to assess obstetric and perinatal outcomes in a large cohort of women aged > 45 and to develop a statistical model predicting VD. Materials and methods: This is a retrospective analysis of prospectively collected data on singleton pregnant women aged > 45 years, with intended VD, at five Italian academic maternity centers between 2016 and 2022. Women with delivery < 22 weeks, and undergoing pre-labor CS, were excluded. The primary outcome was VD. Secondary outcomes included: induction and failed induction of labor; CS for failure to progress or cervical dystocia. The predictive model for VD was built by means of a multivariable logistic regression. Results: During the study period, 625 women were managed at the participating centers, and 293 were included in the analysis. VD occurred in 75.8% of cases, ranging between 67.1% and 86.4% among nulliparous and multiparous women, respectively. Induction of labor (IOL) was performed in 173 women (59%). Among the 71 (24.2%) patients undergoing CS, 25 (35.2%) had a failed induction whereas the remaining 46 (64.8%) had an urgent CS in labor. Among the 222 women with VD, vacuum occurred in 39 (17.6%). The predictive model allows to calculate the probability of VD according to five significant variables: maternal age, pregestational BMI, height, parity, and whether labor was induced or not. Conclusions: The predictive model we developed may help clinicians in counselling women to choose their best childbirth.