Women at or older than 35 are considered to be of an advanced maternal age. They have a greater risk of decreased fertility, increased risk of fetal abnormalities and pregnancy complications.

In addition, women with a previous history of cesarean section are at risk of a condition called cesarean scar pregnancy -- where the gestational sac is implanted within a previous cesarean hysterotomy scar -- and uterine ruptures.

If women at that age want to reduce risks, they must undertake pre-pregnancy health examinations, which are mainly carried out in the following manner:

1. Assessment of fertility

With age, the number of oocytes in the ovary decreases and the fertility of women over 35 years of age decreases markedly, manifested by a reduced pregnancy rate, increased miscarriage rate, increased probability of chromosomal abnormalities in the offspring and decreased live birth rate.

For older women (over or equal to 35 years old) -- especially those older than 40 -- the hospital assesses their fertility to determine the number of remaining follicles in the ovary and the follicles' abilities to combine with sperm to form fertilized eggs.

2. Gynecological examinations

Routine gynecological examinations can help to understand the status of the female reproductive system, mainly including screening for cervical diseases and B-ultrasound examinations.

Neither advanced age nor previous abortion history is an indication for tubal examination. It is suggested that women should return to hospital for relevant examinations if they are still unsuccessful after completing the pre-pregnancy examination and after a period of trial pregnancy.

For many women ready to conceive a second baby, cesarean section is used to terminate the pregnancy for the first delivery and it is recommended that pregnancy be resumed two years after the procedure. Before preparing for pregnancy, women must go to a regular hospital for a comprehensive examination, to understand the recovery of the uterus. Once pregnant, it is necessary to go to the hospital for B-ultrasound examinations in the early stage to determine the implantation site of the gestational sac, to ensure safety.

3. Medical and surgical examination

After 35 years of age, many medical and surgical diseases have a higher incidence. The incidence of cardiovascular disease, diabetes, thyroid disease and kidney disease of women in that age bracket is higher than that for younger women. Therefore, it is necessary to screen for possible diseases and treat them as early as possible before pregnancy preparation, to minimize the risk to the pregnancy.

Generally speaking, given management by specialists to control conditions to within the normal range, women can have a normal pregnancy preparation, helped by drugs taken during the course of the pregnancy. Of course, if a specialist assesses that your current state is not suitable for fertility, it is recommended to follow the doctor's advice and not risk your own life.