AGE AND PARTURITION IN PRIMIGRAVIDAE

THAT youth is one of the greatest virtues which a child-bearing woman can possess and that advanced age may impose a handicap upon her in pregnancy and in labour has been recognized by writers in obstetrics for as long as the practice of obstetrics has existed. To quote a few, Mauriceau declared that labour was more prolonged and more severe, that eclampsia was more common and the resultant mortality, maternal and foetal, was higher in the older age groups. Mme Lachapelle was more optimistic“no doubt one often observes slow and painful labour in older primigravidae but is it not the same in all ages? ” Smellie (1752) in discussing causes of laborious labour, mentions “rigidity of the 0s uteri, vagina and external parts, which commonly happens to women in the first birth, especially to those who are about the age of forty”. He described a case (No. 142)-a primigravida for whom his advice was requested on account of delay in labour. He found “rigidity of the 0s uteri with febrile excitement”. After performing venesection he was able to push up the cervix and safely deliver her. She was “turned of forty”. Denman (1795) also recognized the problem saying “If a woman be far advanced at the time of her having her first child, the difficulty attending her labour may sometimes be expected to be greater”. However, as if to reassure the reader, he continued “it does not constantly happen that the difficulty of labour is in proportion to the age of the patient when she has her first child; that being in many cases, as easy at forty years or upwards, as if she was only twenty-five”. It is unfortunate that so many of the early writers such as Giffard and Smellie failed to give the age of the patient when describing long series of difficult cases at which their advice and assistance were requested. In the majority of them, it is not stated whether the patient was a primigravida or a multipara. The “previous obstetric history”, the importance of which cannot be over-emphasized, is not given. Had this been stated, the interest of these cases, great as it undoubtedly is, would have been much enhanced. While the majority of obstetricians state that an elderly primigravida is one of 35 years or over, opinion is not completely unanimous on this point. Others believe that women over 30 should be classified as such while Dutta (1948) suggests that in India any woman bearing her first child at the age of 26 or over should be looked on as an elderly primigravida. He stresses, however, that women in India mature earlier and that pregnancy is much commoner in his country among younger women than in European or North American countries. On the other hand Donald (1960) considers that to include all women going through their first pregnancy over the age of 35, widens the definition too far and “only confuses the issue by diluting results with large numbers of women who in no sense deserve to be classed as elderly and who run a perfectly normal obstetric course”. He considered that the results obtained by such writers as Miller (1931-32) and Nixon (1931) who, in their papers, discussed only women over the age of 40, to be more worth while. Whatever difference of opinion there may be about the exact number of years at which a woman, pregnant for the first time, becomes an elderly primigravida, it is well recognized that with added years, or as Davis and Seski (1948) charmingly describe &--“in the twilight of the reproductive period”, the function of childbearing is attended with increasing difficulties although these are often exaggerated in the popular mind. Nixon (1931) compared 100 primigravidae between the ages of 40 and 45 with a consecutive and similar number between the age of 20 and 25. He found that in the older group toxaemia of pregnancy, abortion, occipito-posterior positions and breech presentations were three times more frequent, that