Maternal risks associated with pregnancy in women with advanced maternal age

Introduction: The trend towards delayed motherhood has accelerated in developed countries over the last few decades. Advanced maternal age (AMA) is defined as age 35 years and older at the estimated date of delivery. Objective: The aim of this large retrospective cohort study is to assess for the association between AMA and adverse maternal outcomes after adjustment for confounding factors in maternal characteristics and in the obstetric history. Study Design: Mothers of 20 years and older, who delivered singleton babies in Malta and Gozo between 1st January 2000 and 31st December 2014 were studied. All data was derived from the National Obstetric Information System. Results: The study population included 55,943 singleton births. 12.2% (6,838) of mothers were between 35 – 39 years and 2.4% (1,325) were 40 years and older. Significant difference was found between maternal age and BMI (p < 0.0001), maternal smoking status (p < 0.0001), non-insulin dependent diabetes mellitus (p = 0.004), history of stillbirth (p < 0.0001), gestational diabetes (p < 0.0001), pregnancy – induced – hypertension (p = 0.008) and pre-eclampsia (p = 0.008). Significant difference was also found between maternal age and mode of delivery (p < 0.0001). Regression analysis revealed persistent significant differences between maternal age and different maternal outcomes. Conclusion: This study demonstrates that AMA in Malta significantly increases the risk for hypertension in pregnancy, gestational diabetes and caesarean delivery. Care providers need to be aware of these increased risks and adjust their obstetric management according to the individual to ensure optimal maternal outcomes.peer-reviewe

Cervical cancer : the importance of screening and vaccination

Cervical cancer is the fourth most common cancer in women worldwide and it is the most common cancer in women aged 15 to 44 years. The national cervical screening programme was introduced in Malta in 2016, aiming to increase the detection rate of pre-malignant, low- and high-grade cervical disease. The Human Papillonna Virus (HPV) is the main cause of cervical cancer and with the HPV vaccine as part of the national immunization programme, we have a strong and useful weapon in the prevention of infection with this virus.peer-reviewe

Brenner tumour : the rare malignant variant

Brenner tumours were first described by MacNoughton Jones in 1898 in his paper ‘Uterine fibroid with anomalous ovarian tumour.’ In 1907, Fritz Brenner published his article ‘Des oophorona folliculare’ because of the resemblance of the epithelioid nests that Brenner found in his tumour, to Graafian follicles. The semblance to Graafian follicles underpinned Fritz Brenner’s classification of Brenner tumours as a variant of granulosa cell tumour. In 1932, Meyer, revisited the topic of Brenner tumours and clarified that they are different from granulosa cell tumours. However, Brenner became aware of such a publication, 24 years later and did not publish any other articles on this subject.peer-reviewe

Prenatal diagnosis of retroperitoneal lymphangioma : a case report

Retroperitoneal lymphangiomas are rare congenital anomalies of the lymphatic system. Here we report a case of foetal retroperitoneal lymphangioma accurately diagnosed in the third trimester of pregnancy in a primigravida lady, using a combination of ultrasonography and magnetic resonance imaging. Prenatal diagnosis and multidisciplinary team approach is crucial in the management and prognosis of infants with lymphangiomas.peer-reviewe