TOPLINE:

Advanced maternal age did not increase the risk for perinatal morbidity in planned vaginal breech deliveries at term when appropriate management protocols were followed. However, it was associated with maternal challenges, including an elevated risk for caesarean section and postpartum haemorrhage.

METHODOLOGY:

• Researchers conducted a retrospective analysis to evaluate the effect of advanced maternal age on neonatal and maternal outcomes in women undergoing planned vaginal breech deliveries at a hospital in Frankfurt, Germany.
• They included 2029 women with breech presentation at term who selected an option for vaginal delivery from January 2004 to December 2023.
• The participants were stratified on the basis of maternal age as the young maternal age group (< 35 years; n = 1417; mean age, 30.3 ± 3.1 years) and the advanced maternal age group (≥ 35 years; n = 612; mean age, 37.2 ± 2.3 years).
• The primary outcome was neonatal morbidity in successful vaginal breech deliveries, and secondary outcomes were the risk for caesarean section and maternal complications.

TAKEAWAY:

• Compared with young maternal age, advanced maternal age was not associated with increased perinatal morbidity related to the birth mode in planned and completed vaginal breech deliveries.
• The odds of caesarean section were 50% higher in the advanced maternal age group than in the young maternal age group (P < .001).
• After adjustment for parity, the advanced maternal age group showed 50% higher odds of postpartum haemorrhage than the young maternal age group (P = .015).
• The use of epidural analgesia in vaginal birth, perineal injury, high-grade perineal tear, and episiotomy were not significantly different between the two age groups.

IN PRACTICE:

"[The study] findings hold particular relevance for optimizing clinical decision making and informing evidence-based policies regarding the management of breech presentations in women of AMA [advanced maternal age]," the authors wrote.

SOURCE:

This study was led by Bilal Alemi, "FRABAT Collective," Department of Obstetrics and Perinatal Medicine, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany. It was published online on November 24, 2025, in the International Journal of Gynecology & Obstetrics.

LIMITATIONS:

This study was conducted in a tertiary care setting, thus limiting generalisability. The exclusion of patients who underwent planned caesarean delivery may have introduced selection bias.

DISCLOSURES:

This study did not receive any funding, and the authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.