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Advanced Maternal Age
Peripartum Cardiomyopathy
Assisted Reproduction
- Societal impact of pregnancy in advanced maternal age
- Risks of infertility and dangers delaying reproduction are rarely taught even at college or professional graduate level
- Older gravidity is always associated with higher risk
- These risks include:
- Miscarriage
- Pre-eclampsia
- Small for gestational age (SGA)
- Gestational diabetes
- Caesarean section
- Advanced maternal age and IVF is NOT associated with increased risk of ovarian or breast cancer
Peripartum Cardiomyopathy
- Peri-partum Cardiomyopathy (PPCM) is on the rise, possibly associated with increase in maternal age
- Risk factors for PPCM include:
- Black race
- Advanced maternal age
- Tocolytic therapy
- Twin pregnancies
- Early signs of PPCM mimic pregnancy
- Orthopnea, persistent dyspnea, and tachypnea are not typical for normal pregnancy
- Echocardiogram is the Gold Standard for LV systolic dysfunction
- Treatment includes BP control, afterload reduction, diuresis, possible anticoagulation
- Black race and indigence associated with poorer prognosis
Assisted Reproduction
- IUI- intrauterine insemination after ovarian stimulation with clomiphene
- IVF- more potent ovarian stimulation with both egg and sperm being handled outside uterus
- Ovarian Hyperstimulation Syndrome
- Associated with IUI and IVF
- Pathophysiology is associated with increased vascular permeability mediated by hCG or LH
- More prolonged and severe in cycles when conception occurs
- Nausea, vomiting, abdominal bloating in mild to moderate cases; significant ascites and pleural effusions in more severe cases
- Risk of ectopic, interstitial, cervical, and heterotopic pregnancies are increased in ART
