We conducted a cross-sectional study with prospective data collection at the obstetrics and gynecology department of Laquintinie Hospital in Douala (Cameroon), a tertiary referral hospital receiving patients from the Littoral region and beyond. The study was conducted over a period of 8 months, from January to August 2025.

Included were all pregnant women aged 35 years and older admitted for prenatal follow-up or delivery during the considered period. Excluded were patients with incomplete records or with pregnancies that ended in the first trimester or abortions before 28 weeks of gestation.

An exhaustive sampling was conducted, including all geriatric pregnancies recorded in the obstetric register. The final sample size was N = 234.

Information was extracted from obstetric records, delivery registers, and operative reports using a standardized data collection form validated by the research team.

The data were entered and analyzed using SPSS version 26.0. Qualitative variables were expressed as frequencies and percentages.

The study received an administrative authorization from Laquintinie Hospital. Data confidentiality was respected, with anonymization of records.

In older patients, the proportion of cesarean sections is particularly high (50.8%), almost equivalent to vaginal deliveries (49.2%). This frequency reflects obstetric caution due to increased risks associated with advanced maternal age: dystocia, labor abnormalities, fetal distress, and associated comorbidities.

The most frequent indications were dominated by a multi-scarred uterus (16.7%), reflecting a more complex obstetric history in these women. This was followed by severe pre-eclampsia and eclampsia (9.8%) and acute fetal distress (6.8%), two complications more often reported in geriatric pregnancies due to fragile vascular conditions and aging of the uterine-placental unit. Third-trimester hemorrhages (3.8%), malpresentations (2.6%), and cases of macrosomia associated with a scarred uterus (3.4%) complete this high-risk profile.

Nearly one in five patients experienced a complication (20.5%). The most frequent were postpartum hemorrhage (9.8%) and the continuation of severe hypertensive syndrome (4.7%). The most severe outcomes included maternal deaths (3.4%) and rarer conditions such as postpartum cardiomyopathy (0.4%) or puerperal psychosis (0.4%). These figures highlight the particular vulnerability of older patients to hemorrhagic, hypertensive, and cardiovascular complications ( Table 1 ).

A total of 8 maternal deaths were recorded among the 234 deliveries (3.4%), indicating a high lethality rate. The causes are multiple and reflect the pathophysiological complexity of geriatric pregnancies, where hypertensive, hemorrhagic, and cardiovascular complications play a central role. The maternal mortality ratio (MMR) is 3419 deaths per 100,000 live births. This MMR is nearly 7 times higher than the national average in Cameroon (=467/100,000 live births according to WHO 2022). The explanation lies in: the small size of the cohort (N = 234); the specific profile of the patients (geriatric pregnancies, associated pathologies), and the nature of the hospital (a reference center receiving complicated cases).

Severe preeclampsia was the main cause of death (3 cases, 1.3%). This confirms the strong association between advanced maternal age and hypertensive disorders, facilitated by increased vascular stiffness, placentation abnormalities, and the frequent coexistence of chronic comorbidities (essential hypertension, obesity, diabetes). In many African series, preeclampsia is also the leading cause of maternal death, underscoring the importance of appropriate prenatal monitoring.

Two deaths were linked to hemorrhagic complications:

Two deaths highlighted the cardiovascular frailty of these patients:

One death was attributed to acute kidney failure (0.4%), a complication often secondary to severe hypertensive disorders or major hemorrhages. This cause illustrates the multivisceral impact of severe obstetric complications ( Table 2 ).

Out of the 234 deliveries studied, 23 cases of postpartum hemorrhage (PPH) were recorded, indicating a frequency of 9.8%. This rate is relatively high compared to expected data in the general population (approximately 6-8% according to African series), reflecting the particular vulnerability of geriatric pregnancies to hemorrhagic complications.

Perineal tears were the most frequent cause (11 cases, 4.7%). In older women, the fragility of soft tissues, combined with reduced perineal elasticity and sometimes dystocic deliveries, increases the likelihood of traumatic tears leading to PPH.

Uterine atony secondary to prolonged labor was found in 9 cases (3.8%). Advanced maternal age is recognized as a risk factor for uterine inertia, due to decreased myometrial contractility and an increased frequency of labor anomalies, often exacerbated by induction or artificial augmentation.

Retention of placental fragments was reported in only 1 case (0.4%), which remains relatively rare in this series. However, it is a classic cause of PPH, requiring increased vigilance at the time of delivery.

Finally, 2 cases (0.9%) of PPH were associated with severe anemia, which, although not a direct cause, is a major aggravating factor by reducing hemodynamic compensatory capacity and increasing mortality related to blood loss ( Table 3 ).

The proportion of PPH (9.8%) in our series is largely driven by perineal tears (4.7%) and uterine atony/prolonged labor (3.8%). Recent evidence supports a “bundle” approach based on early detection, objective measurement of blood loss, and a standardized combined treatment (oxytocics, tranexamic acid, compression, resuscitation). The E-MOTIVE trial demonstrated a significant reduction in severe hemorrhages with this bundle, which WHO included in its 2023 recommendations [14] [15] .

Given the cesarean rate and risk profiles (advanced maternal age, obesity, preeclampsia), systematic stratification and post-cesarean antithrombotic prophylaxis should be considered according to evidence-based recommendations (intermittent pneumatic compression, compression stockings, LMWH according to risk level) [16] .

Advanced maternal age is associated with an increased risk of gestational hypertension and preeclampsia. In low- and middle-income countries, priorities include early detection, low-dose aspirin for high-risk women, education on warning signs, and harmonization of management protocols; a 2024 synthesis details operational pathways adapted to available resources [17] .

Our results (50.8% cesarean rate) are consistent with international data indicating an increased use of cesarean sections with maternal age [5] [6] . Among women “≥45 years,” a recent meta-analysis confirms a rise in the risk of cesarean delivery and adverse maternal-fetal outcomes, advocating for increased anesthetic and transfusion preparedness [18] .

The frequency of postpartum complications (20.5%) and observed MMR should be considered in light of the severity of risk factors: preeclampsia/eclampsia, hemorrhage, pulmonary embolism, renal impairment, and postpartum cardiomyopathy. Multicentric analyses confirm that advanced maternal age increases the risk of maternal morbidity and mortality, particularly in resource-constrained systems [11] - [13] . These data align with the global synthesis of maternal health determinants, which emphasizes the importance of organizing care beyond childbirth [10] .

Our study is prospective and centered on a reference hospital, allowing for detailed clinical data but limiting generalization (single center, 8-month duration). Additionally, the MMR estimation within an AMA subgroup should be interpreted cautiously; multicentric/case-control studies are necessary to clarify the modifiable factors identified in our results.

Our data support a “high-value” intervention package for AMA: risk-adapted antenatal care (screening for hypertension/diabetes, preeclampsia prevention), intrapartum preparation (available blood, team trained in PPH management, antibiotic prophylaxis), post-cesarean thromboembolic risk stratification, and cardio-renal postpartum surveillance. These measures, supported by local and regional data, could help bring results closer to international standards [4] - [6] [14] - [17] .

These results advocate for:

1. Enhanced prenatal care targeting hypertensive and cardiovascular comorbidities;

2. Intrapartum anticipation with transfusion preparation and thromboembolic prevention;

3. Strict postnatal follow-up, including cardiovascular and renal screening;

4. Development of African multicentric studies dedicated to geriatric pregnancies, to consolidate data and guide local recommendations.