Late pregnancies outcome: assessment of the obstetrical risks at the university hospital of gynaecology and obstetrics, Befelatanana, Madagascar

Background: Late pregnancies incur more obstetric complications compared to pregnancies which happen at age 20 to 34. The obstetrician meets difficult challenges to bring these late pregnancies to term delivery, while minimizing the harmful impacts of this non-modifiable risk factor. In addition, few studies have addressed the issue in developing countries, particularly in Madagascar. This study aims to specify the frequency of late pregnancies and to determine maternal and foetal outcome of these pregnancies over age 40, at the University Hospital of Gynaecology and Obstetrics of Befelatanana (HUGOB), Madagascar. Methods: A cross-sectional study was conducted, including women over 40 years old who delivered after 22 weeks in the exposed group, and randomly recruited parturients aged 20 to 34 who gave birth after 22 weeks in the unexposed group. Results: In Madagascar, and particularly at the HUGOB, frequency of late pregnancies after age 40 is low (1.40%). Our study demonstrates these late pregnancies generate more obstetric complications, including pregnancy-induced hypertension and preeclampsia, caesarean section, postpartum haemorrhage, prematurity, foetal distress and foetal death in utero. Some pathology known to complicate these pregnancies such as gestational diabetes and chromosomal defects were probably underestimated in our study because of insufficient means of screening. Conclusions: Advanced maternal age is a significant risk factor of bad pregnancy outcome. Therefore, monitoring of pregnancy for these women should be far more rigorous in order to identify and manage often predictable complications in this situation.