{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T11:10:21Z","timestamp":1756379421204,"version":"3.44.0"},"reference-count":14,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2018,1,26]]},"abstract":"<jats:p>We discuss the case of a 50-year-old nulliparous woman who conceived after <jats:italic>in vitro<\/jats:italic> fertilisation. She had multiple medical comorbidities and presented an obstetric and medical challenge. She was carefully managed through pregnancy and had a successful outcome. In this report, we explore the medical complexity, as well as ethical and logistic issues involved.<\/jats:p>","DOI":"10.1136\/bcr-2017-222950","type":"journal-article","created":{"date-parts":[[2018,2,13]],"date-time":"2018-02-13T13:00:31Z","timestamp":1518526831000},"page":"bcr-2017-222950","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["21st century obstetrics: a 50-year-old nullip\u2014walk in the park?"],"prefix":"10.1136","volume":"2018","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3790-9256","authenticated-orcid":false,"given":"Deepa","family":"Balachandran Nair","sequence":"first","affiliation":[{"name":"Obstetrics and Gynaecology, The Royal Free Hospital, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dipesh P","family":"Gopal","sequence":"additional","affiliation":[{"name":"Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vinita","family":"Singh","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology, The Royal Free Hospital, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,2,8]]},"reference":[{"key":"2025082803364078000_2018.feb07_2.bcr-2017-222950.1","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1016\/S0140-6736(15)60217-3","article-title":"New and old milestones in reproductive medicine","volume":"385","author":"The Lancet","year":"2015","journal-title":"Lancet"},{"key":"2025082803364078000_2018.feb07_2.bcr-2017-222950.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1614362"},{"key":"2025082803364078000_2018.feb07_2.bcr-2017-222950.3","unstructured":"Knight M , Nair M , Tuffnell D , Kenyon S , Shakespeare J , et al . eds. Saving Lives, Improving Mothers\u2019 Care - Surveillance of maternal deaths in the UK 2012-14 and lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009-14. Oxford: National Perinatal\u00a0Epidemiology Unit, University of Oxford, 2016. (cited 28 Jun 2017)."},{"key":"2025082803364078000_2018.feb07_2.bcr-2017-222950.4","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD003641.pub4"},{"key":"2025082803364078000_2018.feb07_2.bcr-2017-222950.5","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.09250914"},{"key":"2025082803364078000_2018.feb07_2.bcr-2017-222950.6","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/j.semnephrol.2017.05.008","article-title":"Diabetic nephropathy and pregnancy","volume":"37","author":"Bramham","year":"2017","journal-title":"Semin Nephrol"},{"key":"2025082803364078000_2018.feb07_2.bcr-2017-222950.7","doi-asserted-by":"publisher","DOI":"10.1900\/RDS.2013.10.6"},{"key":"2025082803364078000_2018.feb07_2.bcr-2017-222950.8","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1097\/AOG.0b013e3182a603bb","article-title":"Development of a comorbidity index for use in obstetric patients","volume":"122","author":"Bateman","year":"2013","journal-title":"Obstet Gynecol"},{"key":"2025082803364078000_2018.feb07_2.bcr-2017-222950.9","doi-asserted-by":"crossref","first-page":"1748","DOI":"10.1111\/1471-0528.13254","article-title":"Validation of an obstetric comorbidity index in an external population","volume":"122","author":"Metcalfe","year":"2015","journal-title":"BJOG"},{"key":"2025082803364078000_2018.feb07_2.bcr-2017-222950.10","doi-asserted-by":"crossref","first-page":"1756","DOI":"10.1111\/1471-0528.13297","article-title":"The Obstetric comorbidity Index predicts severe maternal morbidity","volume":"122","author":"Bateman","year":"2015","journal-title":"BJOG"},{"key":"2025082803364078000_2018.feb07_2.bcr-2017-222950.11","doi-asserted-by":"publisher","DOI":"10.1111\/jtm.12147"},{"key":"2025082803364078000_2018.feb07_2.bcr-2017-222950.12","doi-asserted-by":"crossref","first-page":"1309770","DOI":"10.1080\/20016689.2017.1309770","article-title":"Ethical issues associated with medical tourism in Africa","volume":"5","author":"Mogaka","year":"2017","journal-title":"J Mark Access Health Policy"},{"key":"2025082803364078000_2018.feb07_2.bcr-2017-222950.13","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e5116"},{"key":"2025082803364078000_2018.feb07_2.bcr-2017-222950.14","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1093\/ije\/dyw354","article-title":"The reversing association between advanced maternal age and child cognitive ability: evidence from three UK birth cohorts","volume":"46","author":"Goisis","year":"2017","journal-title":"Int J Epidemiol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2017-222950","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T10:36:52Z","timestamp":1756377412000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2017-222950"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,2,8]]},"references-count":14,"alternative-id":["10.1136\/bcr-2017-222950"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2017-222950","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2018,2,8]]}}}