International Journal of Reproductive Medicine http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. The Desire for Multiple Pregnancy among Patients with Infertility and Their Partners Tue, 22 Jul 2014 09:37:05 +0000 http://www.hindawi.com/journals/ijrmed/2014/301452/ Objective. To study the predictors for desire for multiple pregnancies and the influence of providing information regarding the maternal and fetal complications associated with multiple pregnancies on their preference for multiple pregnancies. Methods. Couples attending an infertility clinic were offered to fill up a questionnaire separately. Following this, they were handed a pamphlet with information regarding the risks associated with multiple pregnancies. The patients will then be required to answer the question on the number of pregnancies desired again. Results. Two hundred fifty three out of 300 respondents completed the questionnaires adequately. A higher proportion of respondents, 60.3% of females and 57.9% of males, prefer singleton pregnancy. Patients who are younger than 35 years, with preexisting knowledge of risks associated with multiple pregnancies and previous treatment for infertility, have decreased desire for multiple pregnancies. However, for patients who are older than 35, with longer duration of infertility, and those patients who have preexisting knowledge of the increased risk, providing further information regarding the risks did not change their initial preferences. Conclusion. Providing and reinforcing knowledge on the risks to mother and fetus associated with multiple pregnancies did not decrease the preference for multiple pregnancies in patients. Ida Lilywaty Md Latar and Nuguelis Razali Copyright © 2014 Ida Lilywaty Md Latar and Nuguelis Razali. All rights reserved. Randomized Comparison of Isosorbide Mononitrate and PGE2 Gel for Cervical Ripening at Term including High Risk Pregnancy Tue, 01 Jul 2014 00:00:00 +0000 http://www.hindawi.com/journals/ijrmed/2014/147274/ Aims. Prostaglandin E2 is the most commonly used drug for cervical ripening prior to labour induction. However, there are concerns regarding uterine tachysystole and nonreassuring fetal heart (N-RFH). Isosorbide mononitrate (IMN) has been used successfully for cervical ripening. The present study was conducted to compare the two drugs for cervical ripening at term in hospital. Methods. Two hundred women with term pregnancies referred for induction of labour with Bishop score less than 6 were randomly allocated to receive either 40 mg IMN tablet vaginally () or 0.5 mg PGE2 gel intracervically (). Adverse effects, progress, and outcomes of labour were assessed. Results. PGE2 group had significantly higher postripening mean Bishop score, shorter time from start of medication to vaginal delivery (13.37 ± 10.67 hours versus 30.78 ± 17.29 hours), and shorter labour-delivery interval compared to IMN group (4.53 ± 3.97 hours versus 7.34 ± 5.51 hours). However, PGE2 group also had significantly higher incidence of uterine tachysystole (15%) and N-RFH (11%) compared to none in IMN group, as well as higher caesarean section rate (27% versus 17%). Conclusions. Cervical ripening with IMN was less effective than PGE2 but resulted in fewer adverse effects and was safer especially in high risk pregnancies. Kavita Agarwal, Achla Batra, Aruna Batra, and Abha Aggarwal Copyright © 2014 Kavita Agarwal et al. All rights reserved. The Chromosomal Constitution of Embryos Arising from Monopronuclear Oocytes in Programmes of Assisted Reproduction Tue, 06 May 2014 06:40:39 +0000 http://www.hindawi.com/journals/ijrmed/2014/418198/ The assessment of oocytes showing only one pronucleus during assisted reproduction is associated with uncertainty. A compilation of data on the genetic constitution of different developmental stages shows that affected oocytes are able to develop into haploid, diploid, and mosaic embryos with more or less complex chromosomal compositions. In the majority of cases (~80%), haploidy appears to be caused by gynogenesis, whereas parthenogenesis or androgenesis is less common. Most of the diploid embryos result from a fertilization event involving asynchronous formation of the two pronuclei or pronuclear fusion at a very early stage. Uniparental diploidy may sometimes occur if one pronucleus fails to develop and the other pronucleus already contains a diploid genome or alternatively a haploid genome undergoes endoreduplication. In general, the chance of obtaining a biparental diploid embryo appears higher after conventional in vitro fertilization than after intracytoplasmic sperm injection. If a transfer of embryos obtained from monopronuclear oocytes is envisaged, it should be tried to culture them up to the blastocyst since most haploid embryos are not able to reach this stage. Comprehensive counselling of patients on potential risks is advisable before transfer and a preimplantation genetic diagnosis could be offered if available. Bernd Rosenbusch Copyright © 2014 Bernd Rosenbusch. All rights reserved. Feasibility, Acceptability, and Programme Effectiveness of Misoprostol for Prevention of Postpartum Haemorrhage in Rural Bangladesh: A Quasiexperimental Study Mon, 07 Apr 2014 07:08:07 +0000 http://www.hindawi.com/journals/ijrmed/2014/580949/ We explored the feasibility of distributing misoprostol tablets using two strategies in prevention of postpartum haemorrhage (PPH) among women residing in the Abhoynagar subdistrict of Bangladesh. We conducted a quasiexperimental study with a posttest design and nonequivalent comparison and intervention groups. Paramedics distributed three misoprostol tablets, one delivery mat (Quaiyum’s delivery mat), a packet of five standardized sanitary pads, and one lidded plastic container with detailed counseling on their use. All materials except misoprostol were also provided with counseling sessions to the control group participants. Postpartum blood loss was measured by paramedics using standardized method. This study has demonstrated community acceptability to misoprostol tablets for the prevention of PPH that reduced overall volume of blood loss after childbirth. Likewise, the delivery mat and pad were found to be useful to mothers as tools for assessing the amount of blood loss after delivery and informing care-seeking decisions. Further studies should be undertaken to explore whether government outreach health workers can be trained to effectively distribute misoprostol tablets among rural women of Bangladesh. Such a study should explore and identify the programmatic requirements to integrate this within the existing reproductive health program of the Government of Bangladesh. Abdul Quaiyum, Rukhsana Gazi, Shahed Hossain, Andrea Wirtz, and Nirod Chandra Saha Copyright © 2014 Abdul Quaiyum et al. All rights reserved. Body Mass Index and Pregnancy Outcome after Assisted Reproduction Treatment Wed, 05 Mar 2014 16:59:13 +0000 http://www.hindawi.com/journals/ijrmed/2014/257974/ The present study aimed to evaluate the impact of body mass index (BMI) on pregnancy outcome after intracytoplasmic sperm injection (ICSI). The study analyzed pregnancy outcome of 349 women who underwent ICSI by their BMI: <25, 25–<30, and ≥30 kg/m2. The associations were generated by applying logistic regression models. A significant reduction in positive pregnancy outcome was observed among overweight and obese women (odds ratio (OR) = 0.50; 95% confidence interval (CI) = 0.25–0.99 for overweight women and OR = 0.45; 95% CI = 0.20–0.89 for obese women). These estimates show that the pregnancy rates are reduced with increasing BMI. The effect of obesity on pregnancy outcome was absent when three and more embryos were transferred. Our study contributes to the reports linking overweight and obesity with decreased positive pregnancy outcome after ICSI and suggests women’s age, infertility type, and number of embryos transferred to modify this reducing effect. Khaled Kasim and Ahmed Roshdy Copyright © 2014 Khaled Kasim and Ahmed Roshdy. All rights reserved. Theories on the Pathogenesis of Endometriosis Wed, 12 Feb 2014 13:16:34 +0000 http://www.hindawi.com/journals/ijrmed/2014/179515/ Endometriosis is a common, chronic inflammatory disease defined by the presence of extrauterine endometrial tissue. The aetiology of endometriosis is complex and multifactorial, where several not fully confirmed theories describe its pathogenesis. This review examines existing theories on the initiation and propagation of different types of endometriotic lesions, as well as critically appraises the myriad of biologically relevant evidence that support or oppose each of the proposed theories. The current literature suggests that stem cells, dysfunctional immune response, genetic predisposition, and aberrant peritoneal environment may all be involved in the establishment and propagation of endometriotic lesions. An orchestrated scientific and clinical effort is needed to consider all factors involved in the pathogenesis of this multifaceted disease and to propose novel therapeutic targets to reach effective treatments for this distressing condition. Samer Sourial, Nicola Tempest, and Dharani K. Hapangama Copyright © 2014 Samer Sourial et al. All rights reserved. Polycystic Ovary Syndrome, Insulin Resistance, and Obesity: Navigating the Pathophysiologic Labyrinth Tue, 28 Jan 2014 09:25:51 +0000 http://www.hindawi.com/journals/ijrmed/2014/719050/ Polycystic ovary syndrome (PCOS) is a highly prevalent endocrine-metabolic disorder that implies various severe consequences to female health, including alarming rates of infertility. Although its exact etiology remains elusive, it is known to feature several hormonal disturbances, including hyperandrogenemia, insulin resistance (IR), and hyperinsulinemia. Insulin appears to disrupt all components of the hypothalamus-hypophysis-ovary axis, and ovarian tissue insulin resistance results in impaired metabolic signaling but intact mitogenic and steroidogenic activity, favoring hyperandrogenemia, which appears to be the main culprit of the clinical picture in PCOS. In turn, androgens may lead back to IR by increasing levels of free fatty acids and modifying muscle tissue composition and functionality, perpetuating this IR-hyperinsulinemia-hyperandrogenemia cycle. Nonobese women with PCOS showcase several differential features, with unique biochemical and hormonal profiles. Nevertheless, lean and obese patients have chronic inflammation mediating the long term cardiometabolic complications and comorbidities observed in women with PCOS, including dyslipidemia, metabolic syndrome, type 2 diabetes mellitus, and cardiovascular disease. Given these severe implications, it is important to thoroughly understand the pathophysiologic interconnections underlying PCOS, in order to provide superior therapeutic strategies and warrant improved quality of life to women with this syndrome. Joselyn Rojas, Mervin Chávez, Luis Olivar, Milagros Rojas, Jessenia Morillo, José Mejías, María Calvo, and Valmore Bermúdez Copyright © 2014 Joselyn Rojas et al. All rights reserved. Adequacy of the Endometrial Samples Obtained by the Uterine Explora Device and Conventional Dilatation and Curettage: A Comparative Study Wed, 08 Jan 2014 11:54:31 +0000 http://www.hindawi.com/journals/ijrmed/2014/578193/ Aims. Our aim is to compare the adequacy and diagnostic yield of samples obtained by the endometrial Explora Sampler I-MX120 with endometrial specimens obtained by conventional dilatation and curettage (D&C). Methods. A total of 1270 endometrial samples were received in the histopathology laboratories at the King Khalid University Hospital, Riyadh, Saudi Arabia, between 2007 and 2010. In the outpatient clinic, the Uterine Explora Model I was used to obtain 996 samples. The remaining 274 samples were obtained by conventional D&C. Sample adequacy and the clustering of inadequate specimens according to age groups by the two different techniques were compared and statistically analyzed. Results. Out of 1270 endometrial samples, 253 (19.9%) were inadequate. The Uterine Explora was used in 88.5% of these inadequate samples (253 samples), and the remaining 11.5% were obtained by D&C. The insufficient tissue incidence was higher with the Explora (17.6%) than with the D&C (2.2%) and the difference was statistically significant . The ages of the patients, as well as the clinical indications for the procedures, were recorded. Conclusion. This retrospective study demonstrated better specimen adequacy when D&C was used compared to the higher rate of sample insufficiency obtained with the Explora. Maria Abdulrahim Arafah, Ammar Cherkess Al-Rikabi, Rakia Aljasser, and Yaser Adi Copyright © 2014 Maria Abdulrahim Arafah et al. All rights reserved. An Audit of Indications, Complications, and Justification of Hysterectomies at a Teaching Hospital in India Thu, 02 Jan 2014 16:05:34 +0000 http://www.hindawi.com/journals/ijrmed/2014/279273/ Objective. Aim of this audit was to analyze indications, complications, and correlation of preoperative diagnosis with final histopathology report of all hysterectomies, performed in a premier teaching hospital. Methods. Present study involved all patients who underwent hysterectomy at a premier university hospital in Southern India, in one year (from 1 January, 2012, to 31 December, 2012). Results. Most common surgical approach was abdominal (74.7%), followed by vaginal (17.8%), and laparoscopic (6.6%) hysterectomy. Most common indication for hysterectomy was symptomatic fibroid uterus (39.9%), followed by uterovaginal prolapse (16.3%). Overall complication rate was 8.5%. Around 84% had the same pathology as suspected preoperatively. Only 6 (5 with preoperative diagnosis of abnormal uterine bleeding and one with high grade premalignant cervical lesion) had no significant pathology in their hysterectomy specimen. Conclusion. Hysterectomy is used commonly to improve the quality of life; however at times it is a lifesaving procedure. As any surgical procedure is associated with a risk of complications, the indication should be carefully evaluated. With the emergence of many conservative approaches to deal with benign gynecological conditions, it is prudent to discuss available options with the patient before taking a direct decision of surgically removing her uterus. Deeksha Pandey, Kriti Sehgal, Aashish Saxena, Shripad Hebbar, Jayaram Nambiar, and Rajeshwari G. Bhat Copyright © 2014 Deeksha Pandey et al. All rights reserved. Comparative Analysis of Normal versus Fetal Growth Restriction in Pregnancy: The Significance of Maternal Body Mass Index, Nutritional Status, Anemia, and Ultrasonography Screening Sun, 29 Dec 2013 08:59:28 +0000 http://www.hindawi.com/journals/ijrmed/2013/671954/ Fetal growth restriction or intrauterine growth restriction is one of the leading causes of perinatal mortality and morbidity in newborns. Fetal growth restriction is a complex multifactorial condition resulting from several fetal and maternal disorders. The objective of this study was twofold: first to examine the correlation between maternal parameters such as body mass index (BMI), nutritional status, anemia, and placental weight and diameter, and their effects on fetal growth and then to evaluate the effect of early screening by ultrasonography (USG) on the outcome of growth restricted pregnancies. In this study, 53 cases of fetal growth restriction were compared to 53 normal fetuses delivered in consecutive sequence. Growth restricted fetuses were delivered earlier in gestation, when compared with normal growth fetuses. Maternal anemia and malnutrition have significant association with the fetal growth restriction. Maternal anthropometry, such as low BMI, had effects on placental diameter and weight, which, in turn, adversely affected fetal weight. Thus, early USG screening along with robust screening for maternal BMI, nutritional status, and anemia can assist the obstetric team in providing early diagnosis, prompt intervention, and better outcome in pregnancy with fetal growth restriction. Laxmichaya D. Sawant and Shirin Venkat Copyright © 2013 Laxmichaya D. Sawant and Shirin Venkat. All rights reserved. The Australian Community Does Not Support Gender Selection by IVF for Social Reasons Tue, 17 Dec 2013 12:05:17 +0000 http://www.hindawi.com/journals/ijrmed/2013/242174/ This study was carried out to determine the attitudes of the Australian community to IVF by a reliable community poll. Cross-sectional surveys, conducted by telephone of a random sample of 650 Australians were undertaken. The sample was drawn from the residential phone numbers in the Australian electronic “White Pages” and stratified by geographical area with quotas controlled by gender and age to be representative of the Australian population. The participants were asked to answer to three questions about gender selection, and their response was measured as “yes-allowed,” “no-not allowed,” or “undecided” for each of the questions. Whilst 91% of respondents supported the use of IVF to help infertile couples, only 20% supported gender selection within IVF or for family balancing. When it came to the use of IVF only for gender selection, only 17% were in favour. This survey shows that Australian community overwhelmingly opposes gender selection for social reasons. Kovacs Gab, McCrann Julian, Levine Michele, and Morgan Gary Copyright © 2013 Kovacs Gab et al. All rights reserved. The Need for Laparoscopic Ovarian Transposition in Young Patients with Cervical Cancer Undergoing Radiotherapy Tue, 03 Dec 2013 17:47:17 +0000 http://www.hindawi.com/journals/ijrmed/2013/173568/ Maintaining the quality of life by preserving ovarian function in premenopausal patients with cervical cancer undergoing radiation is crucial. This can be accomplished with a simple and safe laparoscopic ovarian transposition procedure. This procedure aims to move the ovary out of the irradiation field, protecting it from direct radiation and irreversible damage and preserving its function. However, this procedure is often forgotten and seldom offered to patients. This review aims to lay stress on and reconsider the importance of laparoscopic ovarian transposition as a simple, safe, and extremely useful procedure. The biological effects of radiation are described briefly and several studies are evaluated, which reveal that this procedure has more benefits than risks. Hariyono Winarto, Eva Febia, Gatot Purwoto, and Laila Nuranna Copyright © 2013 Hariyono Winarto et al. All rights reserved. Temporal Trends in Chorioamnionitis by Maternal Race/Ethnicity and Gestational Age (1995–2010) Thu, 28 Mar 2013 13:42:59 +0000 http://www.hindawi.com/journals/ijrmed/2013/906467/ Objective. To characterize trends in chorioamnionitis (CAM) by maternal race/ethnicity and gestational age. Study Design. We examined trends in CAM from 1995–2010 among singleton births in all Kaiser Permanente Southern California hospitals (). Data were extracted from Perinatal Service System and clinical utilization records. Gestational age- and race/ethnicity-specific biannual diagnosis rates were estimated using the Poisson regression after adjusting for potential confounding factors. Results. Overall diagnosis rates of CAM increased from 2.7% in 1995-1996 to 6.0% in 2009-2010 with a relative increase of 126% (95% confidence intervals [CI] 113%–149%). From 1995-1996 to 2009-2010, CAM increased among the Whites (1.8% to 4.3%, -value for trend <.001), Blacks (2.2% to 3.7%, -value for trend <.001), Hispanics (2.4% to 5.8%, -value for trend <.001), and Asian/Pacific Islanders (3.6% to 9.0%, -value for trend <.001). The adjusted relative percentage change in CAM from 1995-1996 to 2009-2010 was for Whites [preterm 21% (9%–78%), term 138% (108%–173%)], for Blacks [preterm 24% (−9%–81%), term 62% (30%–101%)], for Hispanics [preterm 31% (3%–66%), term 135% (114%–159%)], and for Asian/Pacific Islanders [preterm 44% (9%–127%), term 145% (109%–188%)]. Conclusion. The findings suggest that CAM diagnosis rate has increased for all race/ethnic groups. This increase is primarily due to increased diagnosis at term gestation. Michael J. Fassett, Deborah A. Wing, and Darios Getahun Copyright © 2013 Michael J. Fassett et al. All rights reserved. Natural Killer Cells and Their Activation Status in Normal Pregnancy Wed, 27 Mar 2013 17:32:40 +0000 http://www.hindawi.com/journals/ijrmed/2013/906813/ Increased peripheral blood-activated NK cell counts are associated with increased risk of miscarriage and failed in vitro fertilization treatment. However, assessment of activated peripheral NK cells in normal and pathological pregnancies beyond implantation and early miscarriage has not been described. Total CD69 expressing NK cells counts were measured by flow cytometry in healthy women with singleton pregnancies, including 45 at 11+6–13+6 weeks’ gestation, 46 at 20+0–22+4 weeks, and 42 at 31+6–33+5 weeks. The number of peripheral blood NK cells decreased, whereas the percentage of activated CD69 expressing NK cells increased from the first to the third trimester of pregnancy. This study shows the course of peripheral blood NK cells and activated CD69 expressing NK cells in uncomplicated nulliparous singleton pregnancies. This is a first step in understanding their implication in pathological pregnancies. Beatrice Mosimann, Marion Wagner, Hassan Shehata, Leona C. Y. Poon, Brian Ford, Kypros H. Nicolaides, and Amolak S. Bansal Copyright © 2013 Beatrice Mosimann et al. All rights reserved. Assessment of the Reproductive Health Status of Adult Prison Inmates in Osun State, Nigeria Tue, 26 Mar 2013 15:11:51 +0000 http://www.hindawi.com/journals/ijrmed/2013/451460/ Introduction. All over the world, numbers of prisoners have being increasing with majority in the sexually active age group; hence diseases such as HIV, Tuberculosis and Hepatitis are more prevalent in prisons than in the community. This study thus aims to provide an overview of the reproductive health status of adult prison inmates in Osun State. Methodology. This is a cross-sectional study among adult inmates in Osun State prison. Data was obtained from 209 selected respondents using pre-tested semi structured questionnaire. Result. Majority of the respondents were in the age group 20–39 years with mean age of . 73.2% are aware of STIs, 93.3% HIV/AIDS and 81.3% contraception. 54.6% had multiple sexual partners before incarceration and 23.3% of them used condom always. 89.5% were not involved in any sexual practice inside the prison, 9.1% masturbated and 1.4% had homosexual partners. Less than 6% had access to male condoms gotten from prison staffs and prison clinics. Conclusion and recommendation. No comprehensive reproductive health care system to address reproductive health services in prisons. Respondents’ knowledge about STIs, HIV/AIDS and contraception is good, but their condom usage is low compared with the knowledge. Government should put in place specific reproductive health programmes in prisons. A. I. Olugbenga-Bello, O. A. Adeoye, and K. G. Osagbemi Copyright © 2013 A. I. Olugbenga-Bello et al. All rights reserved. Clinical Effects of a Natural Extract of Urinary Human Menopausal Gonadotrophin in Normogonadotropic Infertile Patients Sun, 24 Mar 2013 10:51:27 +0000 http://www.hindawi.com/journals/ijrmed/2013/135258/ Purified human menopausal gonadotropin (HMG) is a natural product extracted from the urine of postmenopausal women that contains pituitary follicle-stimulating hormone (FSH), luteinizing hormone (LH), and a small amount of human chorionic gonadotropin (HCG). Here we retrospectively conducted a clinical pharmaceutical study on a cohort of normogonadotropic infertile patients addressed to long GnRH-agonist protocol with serum LH concentration ranging from 0.5 IU/L to 1.5 IU/L during the midfollicle phase, aiming at evaluating the effects of purified HMG supplementation during ovarian stimulation. There was no significant difference in either the basic clinical features of the patients or the pregnancy rate (71.4% versus 66.3%, ) or other related indicators of pregnancy outcome. However, there was a higher level of serum oestradiol (E2) on the day of human chorionic gonadotropin (HCG) ( IU/L versus  IU/L, ) but lower fertilization rate (89.1% versus 69.6%, ) in patients getting HMG supplementation and a higher risk of developing ovarian hyperstimulation syndrome (OHSS). We suppose that exogenous LH supplementation is not needed when serum LH concentration of the midfollicle phase is around 0.5–1.5 IU/L during the long GnRH-agonist protocol. Adding exogenous HMG may decrease the fertilization rate and increase the risk of developing OHSS. Rui Hua, Lan Ma, and Hong Li Copyright © 2013 Rui Hua et al. All rights reserved. Metabolite Profiling in the Pursuit of Biomarkers for IVF Outcome: The Case for Metabolomics Studies Wed, 16 Jan 2013 11:14:25 +0000 http://www.hindawi.com/journals/ijrmed/2013/603167/ Background. This paper presents the literature on biomarkers of in vitro fertilisation (IVF) outcome, demonstrating the progression of these studies towards metabolite profiling, specifically metabolomics. The need for more, and improved, metabolomics studies in the field of assisted conception is discussed. Methods. Searches were performed on ISI Web of Knowledge SM for literature associated with biomarkers of oocyte and embryo quality, and biomarkers of IVF outcome in embryo culture medium, follicular fluid (FF), and blood plasma in female mammals. Results. Metabolomics in the field of female reproduction is still in its infancy. Metabolomics investigations of embryo culture medium for embryo selection have been the most common, but only within the last five years. Only in 2012 has the first metabolomics investigation of FF for biomarkers of oocyte quality been reported. The only metabolomics studies of human blood plasma in this context have been aimed at identifying women with polycystic ovary syndrome (PCOS). Conclusions. Metabolomics is becoming more established in the field of assisted conception, but the studies performed so far have been preliminary and not all potential applications have yet been explored. With further improved metabolomics studies, the possibility of identifying a method for predicting IVF outcome may become a reality. C. McRae, V. Sharma, and J. Fisher Copyright © 2013 C. McRae et al. All rights reserved. Pregnancy Outcome of Multiparous Women Aged over 40 Years Sat, 29 Dec 2012 12:42:51 +0000 http://www.hindawi.com/journals/ijrmed/2013/287519/ Objective. The aim of this study was to evaluate the effect of maternal age on prenatal and obstetric outcome in multiparaous women. Materials and Methods. A retrospective case control study was conducted, including women aged 40 years and over (study group, ) who delivered at 20 week’s gestation or beyond and women aged 20–29 years (control group, ). Results. The mean age of women in the study group was years versus years in the control group. Advanced maternal age was associated with a significantly higher rate of hypertension, diabetes mellitus, fetal complication, and 5-minute Apgar scores <7 (). Caeserean section rate, incidence of placental abruption, preterm delivery, and neonatal intensive care unit admission were more common in the older group, but the differences were not statistically significant. Conclusions. Advanced maternal age is related to maternal and neonatal complications. Seda Ates, Gonca Batmaz, Osman Sevket, Taner Molla, Cem Dane, and Banu Dane Copyright © 2013 Seda Ates et al. All rights reserved.