The Burden of Geriatric Pregnancies: Maternal Morbidity and Mortality in a Cameroonian Referral Hospital

Introduction: The geriatric pregnancies (≥35 years) are accompanied by an increased obstetric risk, which is still poorly documented in referral hospitals in sub-Saharan Africa in general and in Cameroon in particular. Objective: To describe maternal outcomes of geriatric pregnancies managed in Douala and to estimate the maternal mortality ratio (MMR) in this population. Methods: A cross-sectional study with prospective data collection, conducted over 8 months (January-August 2025) at Laquintinie Hospital in Douala. All pregnancies ≥35 years (N=234) were included. The variables analyzed were: delivery route, postpartum complications, causes of maternal death, and etiologies of postpartum hemorrhage (PPH). Results: Cesarean sections accounted for 50.8% of deliveries (vaginal delivery 49.2%). Postpartum complications occurred in 20.5% of patients. Eight maternal deaths (3.4%) were recorded, resulting in an MMR of approximately 3,419 per 100,000 live births. Main causes of death included: severe pre-eclampsia/eclampsia (1.3%), disseminated intravascular coagulation (0.4%), hemorrhagic shock (0.4%), pulmonary embolism (0.4%), acute renal failure (0.4%), and postpartum cardiomyopathy (0.4%). PPH affected 9.8% of cases, mainly due to perineal tears (4.7%) and uterine atony/prolonged labor (3.8%), followed by severe anemia (0.9%) and retained placental fragments (0.4%). Conclusion: In this urban referral center, geriatric pregnancies are associated with a high cesarean rate, substantial morbidity, and an alarming MMR. Priority measures are necessary: antenatal follow-up adapted to risk (hypertension/diabetes), PPH bundles with objective measurement of losses, post-cesarean thromboprophylaxis based on risk assessment, and cardio-renal monitoring postpartum. Multicenter studies are needed to refine contextualized protocols.