With the implementation of the two-child policy in China, an increased number of women of advanced maternal age (AMA) have been giving birth. Formulating evidence-based guidance for the clinical management of this population is crucial. This retrospective study aimed to explore factors influencing the mode of delivery in women of AMA. Data on 350 women of AMA who delivered at Shanghai Putuo Maternity & Infant Health Hospital from January to June of 2016 were collected. Results indicated that

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... t (114/134, 85%) of the multiparae chose delivery via cesarean section (CS) because of uterine scarring. There were significant differences in the body mass index (BMI) before pregnancy, BMI at delivery, gestational diabetes mellitus (GDM), pregnancy-induced hypertension (PIH), and placenta previa between the CS and vaginal delivery groups (P < 0.05 for all). The current results suggest that vaginal delivery is recommended for the first delivery whenever reasonable. Moreover, management of metabolic disorders during pregnancy is essential to effectively reduce the rate of CS among women of AMA.