The elderly primigravida has long been a source of interest and anxiety
to the obstetrician and in view of the increasing numbers of the group, she is
becoming ever more important at the present day. Throughout the literature,
many writers from Mauriceau to the present day have noted especial risks
of pregnancy, labour and the puerperium in the upper age groups. On the
other hand we find such statements as "Most accoucheurs have been agreeably
surprised by the ease and rapidity with which elderly primigravidae have
delivered" (Herring,) Again, Schulze observes that, "Practical experience
has shown that although a certain proportion of these women do have serious
difficulty, even a woman near menopausal age may have her first baby with
surprising ease and rapidity." She further points out that the dangers of
labour in the elderly primigravida have been somewhat exaggerated, and that
about twenty per cent of the women have strikingly rapid and easy labours.
It is obvious, however, when statistics are studied which enable comparison
to be made between the upper age -groups and the average for all ages, that
the incidence of many complications at all stages of the reproductive life
is increased. In consequence of the apparent disparity between this fact
and the views quoted above, the question arises as to whether the special
risks are evenly spread over the whole group of elderly primigravidae or whether they are incurred by a sub -group. Several writers have attempted
to describe special types in whom either easy, or difficult labour is to be
anticipated ( Meyer , Jaroschka ) but none has clearly defined these groups.
A study of the characters of the dystocic types as described by
these authors has led to a recognition of the fact that a marked similarity
exists between the groups of elderly primigravidae in whom difficult labour
is to be anticipated and the women showing the dystocia- dystrophia syndrome
as described by De Lee , Bryan Williams , and others. On examination of a small series of twenty -five personal cases of elderly primigravidae this
appeared to be borne out, and a more extensive investigation has been
undertaken at the Liverpool Maternity Hospital, where all cases of women of
thirty -five years of age and over delivered there during the five-year
period 1939 - 43 have been analysed. This Liverpool series numbered four
hundred and sixteen cases.
In this paper, I propose to record results of my investigation as follows: -
1. Evidence that the elderly primigravida incurs a higher risk, and
conclusions drawn from this evidence.
2. Evidence that the features of the dystocia- dystrophia syndrome are in
many instances identical with the complications encountered amongst elderly
3. Evidence that the groups of elderly primigravidae included a considerable
proportion of cases corresponding to the dystocia -dystrophia syndrome, and
that these cases incur the majority of the increased risks attributed to the
higher age -group.
4. Factors of importance in the prognosis of dystocia and their relationship
to the dystocia- dystrophia syndrome.
5. The practical application of these findings in relation to prognosis and