Over recent decades, the number of pregnancies at advanced maternal age has increased worldwide, driven by sociocultural changes delaying motherhood and advances in assisted reproductive technologies [1] [2] . A multicenter study in Israel reported that birth rates among women aged 35 - 39 years and 40 - 44 years increased by 272% and 318% respectively over four decades, with advanced maternal age linked to higher risks of preeclampsia, prematurity, and cesarean delivery [3] . Although such pregnancies are considered high risk, some authors emphasize that age alone does not account for adverse outcomes [4] .

In Sub-Saharan Africa and particularly in Gabon, the frequency and outcomes of childbirth at age ≥ 40 remain poorly documented [5] . African series report variable frequencies ranging between 1.02% and 1.87%, values that are markedly lower than those observed in industrialized countries [6] . The objective of this study was to evaluate the frequency, clinical characteristics and maternal-fetal prognosis of these deliveries considered high-risk, especially in our context.

Among 11,771 deliveries involved women aged ≥40 years (3.2%). Most were 40 - 42 years (80.6%). Multiparity was more frequent in cases (49.1% vs. 40.9%, p < 0.02, Table 1 ).

The number of antenatal consultations (ANCs) differed little between the groups; most women had attended at least three consultations (p >0.008, Table 2 ).

This study has the limits of a retrospective study based on data collection: urgently completed files with summary and poorly archived information.

During this study, we identified two main biases:

During this study period, we observed a frequency of 3.20% of deliveries in parturients aged 40 years and over. Our figure remains slightly high compared to those of the literature, which varies globally between 1.02% and 1.87% in African series. Foumsou et al. [7] in Tchad and Maleya et al. in Congo [8] found frequencies of 2.8% and 2.4% respectively. This difference is to be due to the recruitment of parturients admitted to our service who often have a high socio-economic level compared to the general population.

African series also report elderly parturients: 52 years for Samake et al. [9] in Côte d’Ivoire and 53 years for Ouattara et al. [10] in Burkina Faso.

We observed a large multiparous population (88.6% vs. 75.1%, p < 0.01) as shown by the study by Spellacy et al. [11] .

Pregnancies after the age of 40 often occur in multiparous. 49.1% of our parturients have a parity between 4 and 6. If we consider the large multiparous (parity > 7), they represent 39.5% in our study. Tebeu et al. [12] , in Cameroon, found 94.46% of multiparous in parturients aged 40 years or older.

Western studies have found a decrease in old primiparous, as in the Bellaisch-Allar [13] series. It must be understood that in these countries, success requires professional achievement, women freed from the fear of an unwanted pregnancy prefer to postpone the procreation project.

Our study found 9% of premature babies (term less than 37 weeks) in parturients aged 40 years and over. This rate is higher than that found by Denax et al. [14] , 3.4%. Foix et al. [15] found 6.8% with a high risk of prematurity at the age of 35. On the other hand, for Andriamady et al. [16] , the risk of prematurity is significantly increased by 23.1% among parturients aged 40 years and over.

Childbirth took place spontaneously in 72.7% of cases in parturients aged 40 and over vs. 81.5% in those under 40. The difference is statistically significant. Parturients aged 40 and over have a higher risk of giving birth by caesarean section or instrumental extraction than parturients in the group aged 20 to 34, p < 0.05.

Cesarean delivery is much more common in parturients aged 40 years or older (16.2%) compared to 12.08% in parturients aged 20 to 34 years, but the difference is not statistically significant (p > 0.05). The rate of caesarean delivery is particularly high in this population since it varies according to the authors between 15 and 40% with even higher values in the elderly primiparous, where it reaches 50 or even 70% in the study of Kinenkinda et al. [17] .

No difference was observed in the occurrence of postpartum hemorrhages in both groups of parturients (7.7% vs. 7.0%). Some authors describe a frequency of delivery hemorrhages after 40 years due to the poor quality of the uterine muscle. The study by Tebeu et al. [18] reports a high frequency of hospitalization following childbirth (48.61%) of deliveries.

The thromboembolic risk is increased in the literature, especially if there is a predisposition to the type of superficial or deep thrombophlebitis as in the study of Essiben et al. [19] . Lehmann et al. [20] found a twice as high risk of postpartum hemorrhage and an infectious risk (endometriosis, pyelonephritis) seven times greater than in the control group. Our study did not find thromboembolic diseases and postpartum infections. We systematically use a postpartum antibiotic cover.

The maternal death rate of parturients aged 40 years or older in our study is low, 0.26%. Owono Etoundi et al. [21] report a rate of 1.1%.

The delivery of a woman aged 40 and over is at high risk. Pregnancy follow-up must be rigorous and early and require obstetric-pediatric collaboration to limit the complications associated with this delivery.