Dealing with Down syndrome occurrence risk

There were 28,600 deliveries of 500 g or more to women at the Rotunda Hospital between January 1st 1985 and December 1st 1989. Of these, 595 were to women aged 40 years and over. Thirty-five variables of clinical significance were analyzed, comparing those of 40 years of age and more with those under 40. The older group had significant increases in gestational diabetes, ante-partum hemorrhage, fetal distress, prematurity, low birth weight and perinatal mortality. Chromosome congenital abnormalities were significantly higher, particularly Down syndrome. There were significantly increased rates of induction and cesarean section in the older women. Some evidence of interaction of age with other factors was found, however these were difficult to separate out in the clinical setting. We therefore recommend it wiser to manage all elderly gravidas in a high risk manner dealing with cases individually within this framework. Intervention should, however, need to be justified in the older as in the younger woman