Late pregnancy

Late pregnancy is a gestation that occurs in a woman who is over 35 years of age. In addition to the characteristic signs of a normal pregnancy, patients have more pronounced weakness and fatigue, more frequent edema of the lower extremities, pastous face, headaches, episodes of dizziness, heaviness, and painful sensations in the lower abdomen. The likelihood of complications increases. Late pregnancy is diagnosed by gynecological examination, immunological express methods, and ultrasound of the uterus. Medication therapy with antibiotics, hormonal, tocolytic, antiaggregant and other drugs is used only if indicated.

General information

Since the late 1970s and early 1980s, the number of women worldwide who have decided to have a baby at age 40 or even later has increased rapidly. By the early 2000s, the number of 35- to 39-year-old women giving birth had increased by 90%, and the rate of conception at age 40 or older had risen by 87%. In a number of cases, late pregnancy is the first pregnancy. The relevance of proper support of such gestations is due to the increased risk of obstetric complications and decompensation of chronic diseases, which are more often suffered by middle-aged women. However, the birth of a late first or second child has a number of positive aspects. Usually with increasing age of the patient the level of stress experienced during pregnancy and in the postpartum period decreases, which has a favorable effect on the physical, emotional and intellectual development of the child. According to research in the field of obstetrics, women who gave birth at a mature age have a 32-45% lower incidence of endometrial cancer and 16% lower incidence of ovarian cancer. They go through menopause later, and osteoporosis is less severe.

The Reasons

Optimal time for conception and bearing a healthy child is the age interval from 18 to 35 years. It is during this period that a woman has maximum fertility, and her physical form allows her to give birth with minimal risk of obstetric and extragenital complications. However, there are a number of biological, medical and social prerequisites that contribute to pregnancy at a later age:

• Infertility. Conception and delivery are hindered by abnormal development of reproductive organs, diseases of the ovaries (chronic oophoritis, polycystic disease, sclerosis), fallopian tubes (salpingitis, hydrosalpinx, adhesions, multiple processes), the uterus and its cervix (endometritis, polyps, submucosal myomas, cervicitis, isthmic-cesical insufficiency), pelvic adhesions. Modern treatment methods and reproductive technologies allow women, who previously could not conceive, to become pregnant. In some cases it takes a long time to restore fertility, and gestation occurs after the age of 35.
• Postponement of pregnancy. Some women deliberately postpone plans to create a family, childbearing until a later age because of the desire to build a career, to reach a more stable and higher financial and material level, "to live for themselves". The increase in life expectancy, the expansion of educational and career opportunities, emancipation, changes in public attitudes to the role of women, modern means and methods of contraception play a certain role. As a result, in many developed countries the average age of gestation is increasing (up to 30 years or more), as well as the number of late primiparous mothers.
• Unplanned pregnancies. By age 35-40, most women have family planning issues resolved, and conception may result from disregard for contraception or the ineffectiveness of previous methods of protection. Thus, menstrual irregularities caused by the onset of menopause reduce the effectiveness of the physiological method of contraception, based on the calculation of the date of ovulation. After 35-40 years, female fertility decreases significantly, but this does not indicate the development of infertility. Over 70% of pregnancies of late reproductive age end in medical abortions.

Statistics show a steady increase in divorce rates and the number of women who remarry. In such circumstances, the decision to have a "late" child, not the first, may be dictated by a desire to strengthen a new family. Some older pregnancies are the result of a deliberate refusal to use contraception, dictated by religious views and family traditions.

Pathogenesis

Late pregnancy develops in the same way as in younger patients. However, natural age-related changes in the female body and pathological disorders characteristic of adulthood affect the course of its individual stages. As by the age of 35, the incidence of inflammatory diseases of the reproductive organs increases, leading to a deterioration in the patency of the fallopian tubes, the implantation of a fertilized egg with the formation of ovarian, abdominal, tubal pregnancy may be impaired. Morphological changes in the endometrium associated with past invasive interventions, inflammation, the presence of polyps, submucosal nodules, contribute to the introduction of the fetal egg in the cervical area. Often occurring hormonal imbalance causes the threat of gestational abortion and becomes a prerequisite for violation of the normal contractile activity of the myometrium. An age-related decrease in soft tissue elasticity increases the likelihood of rupture.

Signs of late pregnancy

The appearance of morning sickness, vomiting, aversion to certain odors, changes in food cravings, appetite disorders may indicate the possible onset of gestation in mature women. As at the beginning of a normal pregnancy, patients complain of somnolence, mood swings, irritability, general malaise, and episodes of dizziness. They often urinate, their breasts become heavier and more sensitive, the areolar area and the white line of the abdomen become hyperpigmented, and pigment spots appear on the face. Absence of menstruation, colostrum, a noticeable increase in the circumference of the abdomen are considered to be more likely symptoms of pregnancy. From 16-18 weeks a woman begins to feel the moving of the fetus, from the second trimester its parts may be felt through the abdominal wall.

Complications

The risk of complications during gestation in older patients is 2-5 times greater than in 20-30 year olds. The age of 35-39 years is the peak of multiple gestation, which places an increased burden on the female body even in young pregnant women. Disruption of tubal patency and endometrial structure due to early invasive interventions and reproductive diseases increases the likelihood of late ectopic pregnancy. Ageing pregnant women are 2.7 times more likely to have gestosis, including the most severe form, preeclampsia, 4.5 times more likely to have gestational diabetes, and 3.2 times more likely to have apparent diabetes requiring insulin therapy.

Because of hormonal imbalance, somatic disorders, increased frequency of genetic defects and chromosomal aberrations in the fetus (from 0.08% at age 25 to 5% by the age of 45) the probability of spontaneous miscarriage increases threefold and reaches 33%. Premature births in women with late gestation occur 4 times more often, and sometimes they are induced artificially because of the identified complications. As a result of chronic placental insufficiency there is a 2-fold increase in the frequency of underweight babies. More large fetuses are born (mainly in patients with diabetes).

Because in the third trimester, pregnant women over 40 years of age have an eightfold increased risk of placenta detachment, antenatal fetal death is 50% more common than in younger women. Patients of advanced age often have weak labor, cervical, vaginal, perineal tears, hypotonic bleeding, DIC, and acute extragenital pathologies (myocardial infarction, stroke, retinal detachment) during delivery. Caesarean section is performed in 40% of 35-40 year old pregnant women, after the age of 40 this figure reaches 47%. Maternal mortality doubles with late pregnancies.

Diagnosis

The objectives of the diagnostic stage are confirmation of gestation, early detection of possible fetal abnormalities, dynamic monitoring of fetal development, and identification of possible risks during late pregnancy. A comprehensive examination includes such physical, laboratory, instrumental methods of diagnosis as:

• Gynecological examination. Probable gestation is evidenced by the lividity of the mucous membrane of the vagina and uterine cervix. On bimanual palpation, the shape, size, and consistency of the uterus are altered, and pathognomonic symptoms (Hegar-Gorvitz, Snegirev, Piskacek) are determined. As the pregnancy progresses, the uterus condition is assessed during the chair exam, and pathological contents are sometimes detected in the vagina, indicating complications.
• Immunological tests for pregnancy. The use of modern, highly sensitive methods of rapid diagnosis based on the detection of chorionic gonadotropin in urine or blood serum allows a high probability of confirmation of gestation. The advantage of immunological tests is the speedy results and the possibility of performing them even at home, if the period is late.
• Ultrasound of early pregnancy. Echographic method makes it possible to visualize the fetus in the uterine cavity starting from 3-4 weeks of gestational age, although most often the examination is carried out between 6-10 weeks. Ultrasound is recommended for all patients with suspected pregnancy. In subsequent ultrasound examination is used to monitor the development of gestation (ultrasound screening 1, 2, 3 trimester), the fetus (fetometry) and uterus.
• Diagnosis of developmental abnormalities. Given the risk of chromosomal aberrations and genomic defects in late gestation, methods of noninvasive prenatal diagnosis are used to examine fetal DNA circulating in the blood of the pregnant woman. The standard test for 5 chromosomal abnormalities and the extended test for 10 are highly informative. When indicated, invasive examinations are performed: amniocentesis, chorion biopsy, cordocentesis, placentocentesis.

To assess the course of gestation and the condition of the woman over time, there is a comparison of the CBC, CBC urinalysis, and biochemical test data (blood glucose levels, etc.). If necessary, laboratory tests are prescribed to monitor pregnancy (determination of placental lactogen levels, placental growth factor, free b-CGH, free estriol, trophoblastic β-1-glycoprotein). To rule out infections that lead to intrauterine damage to the fetus, a pregnant woman is examined for TORCH-complexes. The patient is consulted by a general practitioner, ophthalmologist, neurologist, and is examined by a urologist, cardiologist, endocrinologist, infectious disease specialist, pulmonologist, and other specialized specialists, if indicated. Late pregnancy is differentiated with early menopause, uterine myoma, amenorrhea on the background of ovarian insufficiency and other diseases that disrupt the menstrual cycle.

Management of late pregnancy

The objective of medical tactics in the management of pregnant patients of advanced age is the prevention of possible complications (both obstetric and extragenital) and, in the absence of contraindications, planned preparation for natural childbirth. Medical support for late-age pregnancy involves careful monitoring of the patient's health, correction of her lifestyle, and therapy for concomitant disorders. Usually, age-matched pregnant women are recommended:

• Adequate rest and dosage of loads. To reduce the threat of late gestational abortion, it is important to limit heavy physical work, lifting weights, stressful situations. The course of pregnancy positively affects the normalization of night sleep and rest during the day. With insomnia use sedative phytopreparations.
• Correction of diet. Nutrition should be sufficient in calories and balanced in composition, containing foods rich in protein, calcium, iron, vitamins. In the autumn and winter period, it is possible to use vitamin and mineral supplements. When choosing a diet, it is necessary to take into account the recommendations of specialized specialists.
• Preparation for childbirth. Exercises from special LFC complexes for pregnant women, yoga, water aerobics, swimming and pilates classes increase the physical readiness of women for labour activity. Obstetricians and gynecologists observe that such patients give birth more quickly, easily and with fewer complications.

Various groups of medications (antibiotics, antispasmodics, tocolytics, antiaggregants, peripheral vasodilators) are used under indications, taking into account their possible effect on the fetus. Sometimes the prescription of hormones is required to preserve gestation. Although cesarean section delivery is more common in pregnant women of late reproductive age, natural childbirth is preferable in the absence of serious obstetric contraindications (narrow pelvis, large baby, oblique or transverse fetal position, placenta previa) and severe somatic disorders, given proper prenatal preparation.

Prognosis and prevention

In healthy pregnant women aged 35 years and older, with well-organized medical supervision, gestation in 90% of cases proceeds without complications, and can be completed naturally. For preventive purposes, pre-pregnancy preparation with visits to obstetrician-gynecologist, internist, optometrist and, when indicated, other specialists is recommended for women planning a late pregnancy. Preconception involves sanitation of chronic infections, karyotyping to rule out chromosomal abnormalities in the fetus. After conception, an early registration at an antenatal clinic, selection of the best pregnancy management program, conscientious performance of medical recommendations are important.

Can you get pregnant during menopause

Pregnancy during menopause - possible or not - this question, in fact, rarely worries women. After all, in the head actively lives the belief - there is no menstruation, there is no possibility to get pregnant.

In fact, it is not so? Unexpectedly, right? In our article we offer to consider all aspects of the question - is it possible to get pregnant during menopause.

Surely at least half of us have heard stories of an unexpected pregnancy in an "adult" woman. And this, indeed, is not so rare. All because menopause is considered by many to be a "golden time" for women - enough sexual experience has accumulated, while there is no chance to conceive, therefore, unplanned pregnancy is impossible - you can take advantage of the situation and spend time with pleasure.

How the menopause proceeds

The decline in menstruation proceeds in several stages:

Menstruation becomes irregular, the duration of periods without bleeding can vary. Such a period can last for several years.

Such a period can be talked about if a woman has not had menstrual bleeding for 12 months.

The further life of a woman after menstruation has completely disappeared and is absent for more than a year.

Features of pregnancy in menopause

Often a woman who has entered the period of menopause, simply does not notice the pregnancy. She writes off the absence of menstruation to the reproductive decline, weight gain, changes in appetite and hot flashes - to the manifestations of menopause. In such cases, the fact that she is "in the position" the woman learns in 3-4 months of pregnancy, and sometimes later.

Pregnancy during menopause: What is important to know

There are several unexpected facts associated with pregnancy during menopause. It turns out that:

• The likelihood of conceiving during premenopause is slightly less than before it! According to scientists, it decreases by only 10 percent per year. Consequently, the first 2-3 years of irregular menstruation, the probability of getting pregnant may be quite high.
• Hormone replacement therapy during menopause is not a contraceptive, as, unfortunately, some women think.

Oral contraceptives may help reduce the symptoms of menopause, such as irritability, hot flashes, fever. But an experienced doctor should choose the drugs. You can remotely consult with our gynecologist by phone and receive recommendations on the choice and use of drugs.

How to recognize pregnancy during menopause

If in normal times, women, some more, some less control their menstrual cycle and in the presence of a delay do tests and consult a doctor. During menopause the absence of menstrual bleeding is the norm, so no one will even think about becoming pregnant because of the "non-menstrual coming".

Signs of pregnancy during menopause

They are somewhat different from the usual symptoms and may represent:

• Swelling of the breasts
• Colostrum from the nipples

It is important to understand that these manifestations appear in the middle of pregnancy. In any case, if you suspect pregnancy or if similar symptoms appear, you should contact a specialist. An initial consultation can be obtained remotely from our doctors at any time.

How to suspect pregnancy

At the beginning of menopause, when menstruation only begins to become irregular, the possibility of conception remains. Therefore, while neglecting the means of protection, it is important to do periodic pregnancy tests. Or continue to use barrier contraception during intimacy.

An example from practice:

A woman consulted a gynecologist with complaints of severe fatigue, bloating, and nipple discharge. Her medical history indicated irregular menstruation during the last year. During the examination the gynecologist suspected a possible pregnancy, which was confirmed by an ultrasound scan and hCG blood test.

Which test is more effective?

In order not to worry about uncertainty for a long time, you can take an express test that determines the presence of fetoproteins in the urine. These are such special substances that resemble hormones, their task is to stimulate fetal growth. Therefore, their detection can fairly reliably tell you that a woman is expecting a baby.

Does it make sense to take birth control during the menopause?

Of course, there is no desire to get pregnant. Preventing during this period has a number of peculiarities:

• If a woman takes estrogens, including those of plant origin, then it is no longer worth taking OCs, that is, oral contraceptives i. In this case, it is recommended to give preference to barrier methods of contraception.
• Count on the method of "safe days" in the premenopause is not worth it, because ovulation is not according to plan and can, roughly speaking, happen on any day.

Note! An important rule of contraception is not to forget about it for a year after your last menstrual period.

Frequent Questions

Yes, it is very likely. I will say more - to conceive during this period is almost as likely as before this time. According to scientists, the ability to get pregnant during premenopause decreases by 10-20 percent each year. Some more likely (if they have diseases of the reproductive organs, hereditary predisposition, etc.) But overall, a woman can remain quite fertile!

Some people find this fact unbelievable, but in fact it is true. Fertility loss usually does not happen overnight. Hormone levels decrease gradually. External manifestations, such as an irregular menstrual cycle or even the complete absence of menstruation is absolutely no guarantee that the body has completely lost the ability to conceive.

Yes, it is possible. Such cases are rare and even attributed to casuistry, but every gynecologist in practice has such a patient and more than one.

Just like during a regular menstrual cycle - having unprotected sexual intercourse. Yes, the likelihood of conception during premenopause and menopause is lower. But it is far from zero. Therefore, if pregnancy is not included in the plans, it is recommended to use methods of protection for at least a year after the last menstruation.

There are situations when pregnancy comes very unexpectedly In particular, in this row, in second place after immaculate conception, is pregnancy at menopause. In this article you will learn how menopause and pregnancy are related, how to distinguish pregnancy from a uterine tumor and how it all ends for a woman.

Is it possible to conceive during menopause: Grandmothers, protect yourself!

Climax or menopause in women comes at different periods of life, for example, early menopause can knock at 35 years old. Often it happens so suddenly, that it causes depression and permanent stress, because many by this time have not had time to have children and only planned this event. Some people go through menopause after the age of 55. In this situation, the children have grown up, and already growing grandchildren. In both cases, do not relax. Both in early menopause and classic menopause, pregnancy, even in the absence of menstruation, is not excluded.

Doctors say unequivocally that it is possible to conceive within two years after your period ends. Reproductive function of the ovaries remains active for some time, so after the onset of menopause, ovulation persists. Often menstruation stops and then starts again. If a woman is not planning to get pregnant, you need to continue to protect yourself during sexual intercourse for at least another six months.

How to detect pregnancy at menopause: and they were born kolobok...

Remember the old Russian fairy tale about kolobok? Grandma and grandpa scraped the bag, and lo and behold - there was a restless son. In fact, there's nothing fabulous about it. Women in the age of "over..." are treated almost daily in gynecology with such bumps.

When a grandmother suddenly begins to grow a belly, the first thing that is assumed - "myoma. But myoma turns out to be a pregnancy of about 12 weeks. And here is where the question arises, how experienced women who have repeatedly experienced childbirth, did not realize that they are pregnant? Diagnosis of pregnancy during menopause is exactly the same as in the normal state. And it is difficult not to notice these signs, especially if a woman is pregnant for more than the first time.

Pregnancy during menopause can be diagnosed by the following signs (there may not be all):

1. Frequent changes in mood and emotional background: you want to cry, memories are flooding in, it seems that those around you are not attentive enough.
2. A palpable increase in weight.
3. Recurrent dizziness.
4. Occurrence of toxicosis: nausea after eating and when feeling sharp smells.
5. Increased mammary glands.
6. Increased sweating.
7. Absence of bloody discharge from the vagina.

Yes, the symptoms are similar to those of menopause, but they are more acute with pregnancy. This is due to changes in the hormonal background of the expectant mother. To clarify the condition, you need to take tests and undergo ultrasound examinations, and not wait until the "colobus" starts to move.

Pregnancy test, tests and ultrasound pregnancy in menopause

During menopause, the hormone hCG is no longer able to secrete the same amount as before. Therefore, the pregnancy test, bought in the pharmacy, can not catch it because of the low threshold of sensitivity to this hormone. To confirm the presence of pregnancy will help:

• A blood test for beta hCG.
• Transvaginal ultrasound.
• Gynecologist's report.

Read more about all methods to diagnose pregnancy here.

Symptoms of uterine myoma: it does not look like pregnancy!

As a rule, uterine myoma (regardless of its size) does not declare its presence with any symptoms, in which case it is diagnosed during a standard gynecological examination. An asymptomatic course is particularly characteristic of interstitial and subserosal myomas.

If myoma gives signs, they are very different from the state of pregnancy:

1. Menstrual bleeding becomes prolonged and profuse.
2. Between menstrual periods, there is a bloody discharge. Menstrual periods become irregular.
3. The patient experiences tensive, prolonged pain in the lower abdomen.
4. The circumference of the abdomen enlarges considerably, but the body weight does not increase much.
5. Constipation, frequent urination, and pressure is felt in the lower abdomen.
6. Infertility, difficulties with conception.

Identify myoma in a patient using the following diagnostic techniques:

• Ultrasound of the pelvic organs.
• Diagnostic laparoscopy, hysteroscopy.
• MRI of the pelvic organs, computed tomography.

Conception in artificial menopause: hormone replacement therapy can help

Sometimes doctors create menopause in a woman with the help of medication. This forced measure is necessary in the treatment of diseases of the female reproductive organs, including malignant tumors. However, there is no need to give up on yourself right away. Medicine recorded a lot of cases of pregnancy even with artificially induced menopause, and the babies were born healthy, and nurturing proceeded without pathological complications.

To get pregnant at the artificial menopause, you need at the end of treatment, to undergo rehabilitation therapy with hormones. As a result of hormone replacement therapy, menstruation will resume and the egg will be able to be fertilized.

When you get pregnant at the artificial menopause, unfortunately, the symptoms of menopause are intensified. A woman should be prepared to have to endure:

• High blood pressure.
• Hair loss and brittle nails due to lack of calcium in the body.
• Varicose veins.
• Burning sensation and pain during urination - thrush worsens, etc.

For women who decide to have a child during menopause, doctors recommend registering with a gynecologist immediately after conception to avoid possible health problems.

What complications can there be: the queen gave birth in the night, not a son, not a daughter

Modern women are in no hurry to have a baby for a number of reasons: career, finding a suitable father for the baby, or health problems. So most often they think about the first child after 30 years, when they are already able to meet the needs of life.

From a medical point of view, the optimal age for a woman to have a baby is from 20 to 32. During this period, there is a large number of eggs in the body that are ready for fertilization. In addition, many chronic diseases have not yet settled in the body, and this greatly increases the possibility of a healthy baby.

During menopause, an exacerbation of all processes in the female body: the activation of chronic diseases, deterioration of the liver and kidneys, metabolic and hormonal disorders. All this implies a certain risk when conceiving a child during menopause, not only for the baby, but also for the woman herself. According to experts, even if menopause has just begun, the eggs are already being produced incompletely. And this only increases the likelihood of having a baby with genetic abnormalities and congenital diseases. So we can say that menopause and pregnancy in many cases are incompatible.

Menopause and pregnancy: what to do?

Doctors say: to conceive a baby after 50 years - the task is quite feasible. But experienced experts do not advise to take such a risk with their health and the life of the child. Moreover, a woman at this age should be realistic about the situation and in the first place think about the future of the baby. He needs to grow, educate, educate. And to take care of an infant at age 50 is much more difficult. If you decide to carry to term - immediately examine the pregnancy.

If the attending physician and life experience suggest that pregnancy will lead to serious problems, it is better to do medical abortion. Termination of pregnancy in this way passes without surgical intervention and severe complications.

Today, planning for pregnancy, a responsible approach to carrying the baby, childbirth - is not just a norm, but a necessity. And to be prepared for it you need to be together - the expectant mother and the father.

Pregnancy after 40

A woman may want to have a baby after forty years of age for various reasons. Some people did not have the opportunity to become a mother earlier. Others want to prepare - to build a successful career, to realize themselves. Still others have children, but they realize they are ready for one more child.

Until recently, experts insisted that it is better to plan addition to the family until the age of 35. So it is not surprising that the pregnancy after 40 years, not every woman decides - too many fears because of the risk of complications. But many fears are exaggerated. Today in Europe, most couples begin to think about the first child after thirty. By the way, they do not use the offensive word "old-born," which scares in our antenatal clinics.

What are women who want to get pregnant after forty afraid of?

Pregnancy after 40: risks

Some of the listed problems may indeed arise, but others are unfounded or unlikely. Let's see which dangers are real and which are figments of the imagination.

Pregnancy is associated with hormonal restructuring, which can manifest itself in different ways. Some women become overly sensitive, vulnerable, cry on any occasion. Others become very tired. Others, by contrast, feel a surge of strength, become active and energetic. It is believed that between the ages of 18-35 years these fluctuations have less impact on women's health, the body adapts to them more easily.

By the age of 40, the body's condition worsens, chronic diseases appear, and some organs work worse. And so the "hormonal storm" can cause a worsening of some problems, a deterioration of health. But in reality, complications from chronic diseases during pregnancy can also occur in young mothers. And mood swings many women manage to control even better than when they were young.

From a medical point of view, after 40 years of age a woman's body undergoes the following changes:

It is these age-related changes that can cause complications of late pregnancy:

It is also worth bearing in mind that the quality of eggs and the condition of the endometrium deteriorate with age. Therefore, to conceive after 40 years of age can be difficult. Unsuccessful attempts do not have the best effect on the emotional state of the woman. And a bad mood in turn causes an increase in prolactin levels, which blocks pregnancy. The result is a vicious circle. But it can also be broken, if you can competently approach the preparation for pregnancy.

How to prepare for pregnancy at 40?

Preparing for a late pregnancy should begin in advance. The first stage is giving up bad habits (smoking, alcoholic beverages, drugs), stopping taking hormonal contraceptives.

Another important point is to get your diet in order. Give up fatty, spicy, sweet food, fast food, but do not forget to delight yourself with your favorite tasty dishes. Your diet should include: meat, fish, seafood, dairy products, legumes, nuts, vegetables and fruits.

Remember that with age, vitamin and mineral deficiency is exacerbated. Compensate it will help special complexes to prepare for conception. For example, Pregnoton contains folic acid, iodine and other micronutrients, which are especially important in the early stages of pregnancy.

In women over the age of 35, preparation for pregnancy should include taking antioxidants, which protect the maturing eggs from damage and also reduce the risk of pregnancy complications. For example, the complex Synergyin contains coenzyme Q10, which minimizes the likelihood of preeclampsia (a serious complication accompanied by edema, high blood pressure).

You will also have to get your weight in order. If you are overweight, you must lose weight gradually, without sudden loss of kilograms, otherwise your menstrual cycle can be disrupted, which reduces the likelihood of conception.

Do not forget to take care of your own health:

It is important to understand that you do not just have to prepare for conception and pregnancy, and that it includes many points, albeit not very nice, but it allows you to avoid many risks later.

In particular, both partners should visit specialists and be examined. A woman's first priority should make an appointment with a gynecologist. He will not only check up, but also appoint the necessary tests, consultations specialist. A meeting with a cardiologist, endocrinologist, therapist will be needed to assess the state of health, the risks of pregnancy, not only those who have chronic diseases. it will reduce the risks to a minimum.

Psychological aspects

First of all, you need to enlist the support of the future father: talk frankly with your partner, tell him not only about your dreams, plans, but also about your fears, discuss the possible risks. Find out if he is ready to become a father at this age.

Late pregnancy is associated with various psychological problems: fear for the baby, increased anxiety can lead to psychosomatic disorders. This is especially characteristic of those women who are going to become a mother for the first time. Usually they are very mistrustful, but it happens otherwise: a woman is confident in her knowledge and strength, so she even argues with doctors on any issue.

Therefore, it is extremely important to find a specialist for pregnancy management that you will fully trust, his appointments should not cause doubts. Remember, every case is unique: do not ignore the doctor's recommendations, rely on the experience of other women.

If you really want a baby, but are afraid that it will not accept colleagues, relatives, friends, remember that any fear is destructive. Perhaps in your environment will be those who will condemn your choice, but there will be those who will support. Nevertheless, only you can manage your own life and any important decisions concern only you.

It is also important to remember the pluses of pregnancy at a mature age, and there are many:

1. There is a hypothesis that adult parents give birth to genius children. This is easily confirmed by the example of famous historical figures. Wolfgang Amadeus Mozart was a late child. Konstantin Zhukov was over 50 years old when his son Georgy, who later became a Soviet marshal, was born. Peter Tchaikovsky was also a late child. British scientists have concluded that the IQ of children born to mothers after the age of 40 is higher than that of their peers.
2. Older parents take more responsibility for their child's upbringing, devote a lot of time to it, actively participate in its development and education.
3. It is easier for a woman to follow a doctor's prescription, to monitor changes that occur to her, she is more protective of her future child.
4. Pregnancy helps many women to feel younger - they get a "second wind".
5. As a rule, at the age of forty it is easier for a couple to provide themselves and the child with everything they need, so pregnancy will not be accompanied by hard thoughts about the future.
6. Adult women cope more easily with the problems that may arise during pregnancy and childbirth. A great deal of life experience and knowledge helps them feel more confident.

Children are happiness, no matter how old their parents are. Therefore, if you want a child, do not give up on your dream.

Elena Berezovskaya, a famous doctor-researcher, obstetrician-gynecologist, the founder and the head of the International Academy of Healthy Life in Toronto, Canada, told about the nuances of pregnancy after 40. Elena Petrovna does research work in the departments of maternal and fetal diseases and clinical research in the department of obstetrics and gynecology.

Elena Petrovna, how does the age of an expectant mother affect the course of pregnancy?

The topic of pregnancy planning age is perceived differently by women around the world. In developed countries the average age of women planning their first pregnancy is 30 years and older. However, professional societies of obstetricians and gynecologists in Europe and North America claim that the age of 20 to 30 is the optimal age in terms of the lowest rate of complications from the mother and fetus. The older the woman, the worse the quality of eggs, the more problems with conception and carrying a pregnancy.

Unfortunately, post-Soviet women perceive such information more aggressively and negatively. "I feel 25!", "My acquaintance gave birth at 42 to a healthy baby!" - these and many other arguments are used because of resentment and anger that the doctor dared to remind about the relationship between age and pregnancy. No one denies that a woman can get pregnant after 40 and have a healthy baby. But the number of successful pregnancies at that age is the tip of the big iceberg, where pregnancy loss rates and other reproductive problems are underwater and, alas, are hardly ever discussed publicly by anyone.

Are there specifics in preparing for pregnancy for women in their 40s?

With age, all cells of the female body, all tissues and organs age. Therefore, even with excellent health, not all organs are functioning well.

Most often, by the age of 40, thyroid function begins to suffer (thyroiditis appear), the cardiovascular system (hypertension occurs). Many women begin to suffer from obesity, as well as diabetes of pregnancy. Of course, a healthy lifestyle plays a big role in the prevention of many diseases.

Thus, preparation for pregnancy at age 40 and older will affect the assessment of a woman's general condition and the work of those organs that will be under great strain during pregnancy. In general, taking folic acid is recommended for all women planning a pregnancy. It is important for the doctor to explain in detail the risks of age-related pregnancy.

What are the nuances of managing a late pregnancy? What should the expectant mother pay attention to?

First of all, the doctor must determine whether the woman is at high risk for pregnancy complications. This takes into account not only complaints, but also the history of past pregnancies, past or existing diseases.

The presence of risk factors will determine the need for monitoring by doctors specializing in certain diseases or conditions, including possible pregnancy complications. This does not mean that the prognosis of the pregnancy will be bad. It just helps not to miss the moment when complications appear and provide timely and better care.

Healthy women can be managed by a family doctor or nurse-midwife (which is quite normal in most countries of the world), or by a general obstetrician-gynecologist. If necessary, women can also be managed by an endocrinologist, psychiatrist, rheumatologist, oncologist, therapist, etc.

What are the risks and how to minimize them?

Women aged 40 years and older lose pregnancies early in pregnancy more often (more than 60% of losses). They are more likely to have bleeding, in any trimester, as well as complications such as hypertension, pre-eclampsia, deep leg vein thrombosis, thromboembolism, and diabetes.

Preterm pregnancies are more often accompanied by placenta previa, premature placental detachment, and preterm labor.

Rates of stillbirths, birth complications, and surgical interventions (cesarean section) are higher. Children are more likely to have malformations, the weight of newborns is also often lower compared to children whose mothers are younger.

Complications of pregnancy and childbirth are the leading causes of death for mothers over 40 years old. The rate of postpartum depression and suicide is extremely high in these mothers. All of these and other risks have been studied in detail through numerous clinical studies, so they are not fiction or overreaching. But publicly these data are not widely discussed - and this is a huge disadvantage, preventing women from soberly assessing the situation and making rational decisions.

Risk reduction depends on lifestyle, including diet and exercise, reducing or eliminating the influence of bad habits, as well as the qualifications of the doctor who will timely notice abnormalities and prescribe additional examinations and the right treatment.

In late reproductive age there is a gradual preparation for menopause, the ratio of hormones changes, how can this affect the health of the expectant mother and baby?

At the age of 37-38, a new wave of accelerated oocyte destruction begins in almost all women without exception (which is why performing IVF with your own eggs after 38 is often a problem). Also, the levels of a number of hormones begin to fluctuate, especially their proportions, which leads to the appearance of ovarian cysts, the growth of fibromatous nodules. All of this can have a negative impact on conception and carrying a pregnancy. At the same age, ovarian tumors (various cystomas) begin to appear, including those that are borderline malignant.

Not all women tolerate pregnancy and childbirth well after 40 years of age, despite the experience, if the pregnancy is repeated. This is due to greater fatigue, worse adaptation of the body to the new role. And here the individual response is often unpredictable.

Pregnancy itself does not hasten the onset of menopause, that is, it does not lead to rapid depletion of the ovaries and the death of eggs. However, the type of delivery plays a big role: caesarean section increases the risk of early menopause because of possible damage to the blood supply and nerve endings (innervation) of the ovaries.

The health of children depends on the genetic quality of the mother's and father's germ cells, as well as on how the pregnancy and childbirth proceeded. This topic is now being seriously studied by epigenetics.

There is an opinion that after the age of 40 one can give birth only by cesarean section. is this true?

This is not true. Although pregnancy and childbirth after 40 are accompanied by a higher rate of complications, most women can still give birth on their own by natural means. Compared to first-born women in their 30s, the rate of elective and emergency cesarean sections is more than 4 times higher in women 40 and older (43% vs. 25%). This is associated with high rates of hypertension in pregnant women, preeclampsia and other pregnancy complications. Also, the length of hospital stay after delivery is longer in women over 40 than in younger mothers.