Characteristics of pregnancy and childbirth in a 57-year-old woman (Clinical case)

Abstract

Pregnant women of late reproductive age (LRA) (35-49 years) belong to the group of increased risk for obstetric and gynecological pathology, including gynecological diseases, miscarriages, primary or secondary infertility, and in most women it is the first pregnancy. It this article it was presented the case of Pregnant women of late reproductive age (LRA) (35-49 years) belong to the group of increased risk for obstetric and gynecological pathology,including gynecological diseases, miscarriages, primary or secondary infertility, and in most women it is the first pregnancy. It this article it was presented the case of pregnancy and delivery of 57 years old women. In August, 2022 an interesting clinical case was observed at the Scientific Research Institute of Obstetrics and Gynecology. Patient N, 57 years old, referred to the Outpatient Department by the Mandatory Medical Insurance. Necessary examinations (general analysis of blood, general analysis of urine, coagulogram, sugar in blood, USG, CTG, etc.) were conducted and "Pregnancy 37 weeks. Transverse situation. Hypertension of pregnancy. Infertility secondary (15 years). IVF. Uterus fibroids" was diagnosed. According to the woman's anamnesis, she started a family late and the first spontaneous pregnancy was at the age of 42, which resulted in intrauterine death and late miscarriage due to severe preeclampsia at 20 weeks. No spontaneous repeat pregnancy occurred in the subsequent period. The woman became pregnant at the age of 57 from the 3rd attempt through assisted reproductive technologies.
Before planning a pregnancy, appropriate examinations were performed in the care of extragenital diseases and no contraindications for pregnancy were prescribed. During pregnancy, the woman received support (Progesterone), anticoagulant treatment (Clexan 0.4 subcutaneously every day), hypotensive therapy (Dopegit 500-750mg). In the 38th week of pregnancy, a Caesarean section was performed under spinal anesthesia. During the operation,a  live male child weighing 2800 g and height 48 cm was removed from his legs. During the operation, due to the close union of the placenta, the technique
of manual separation was applied, and the parts of the placenta were carefully removed completely, there were no bleeding, calcinations and dystrophic changed areas were visually determined in the placenta. Myomectomy was not performed because
the intramural fibroids of the uterus were not larger than 2 cm. Double sutures were placed on the uterine wound, after checking the tonus of the uterus, the surgical wound was sutured in layers, keeping a drainage tube in the abdominal cavity. The postoperative period was uneventful, appropriate uterotonic, hypotensive, anticoagulant therapy was performed. The condition of the newborn was also stable and satisfactory. 3 days after the operation, the woman and the newborn were discharged home in stable enough condition. The control examination was performed on the woman and child 10 days and 1 month later, their conditions are stable. A late fall of the navel of the newborn (on the 15th day) was recorded. The woman’s blood pressure is stable (140/90 mmHg) is currently taking antiagregant treatment for the prevention of cardiovascular diseases. Thus, women of late reproductive age and menopause are primarily at risk of pregnancy complications and constitute a risk group for maternal and perinatal mortality. This is a certain group of pregnant women, for which a special reproductive health program should be created.