Obstetric management and perinatal outcome of extreme prematurity: a retrospective study

The aim of this retrospective study is to evaluate the obstetric management and perinatal outcome of extreme prematurity (22-27 weeks) in a busy teaching hospital between April 2004 and March 2005. A total of 57 babies were delivered in 49 women representing 0.9% of total births. A total of 67% of babies were transferred to the NICU and the survival rate for those who were admitted to the NICU was 47%. The overall survival rate for all births at hospital discharge was 32%. Caesarean section was carried out in 32% of the 49 mothers. The overall survival at discharge in these babies was 50%. Only 12.5% of babies delivered by caesarean section at less than 27 weeks survived as compared with 70% survival rate at 27 weeks. There was no survival among babies delivered by caesarean section below 26 weeks. Gestational age of the neonate was the single most important parameter related to survival at 7 days, 30 days and 90 days/discharge, even after adjusting for other parameters like birth weight, sex of baby and maternal chorioamnionitis. Birth weight was an independent risk factor for survival, with a birth weight of 900 g; the survival rate was significantly higher. Hypertensive disorder was the most common maternal medical complication and responsible for 7/16 caesarean sections. The study highlighted the importance of the multidisciplinary team management and the involvement of parents in the decision regarding management of these very pre-term babies, during labour and after delivery.