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Periviable birth: Interim update.

, Jeffrey L Ecker, Anjali Kaimal

American Journal of Obstetrics and Gynecology

|April 23, 2016

Summary

This summary is machine-generated.

Periviable birth, occurring between 20 and 25 weeks gestation, presents complex decisions for families and clinicians. Understanding factors influencing outcomes and available interventions is crucial for informed decision-making.

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Area of Science:

Neonatalogy
Maternal-Fetal Medicine
Bioethics

Background:

Periviable births (20 0/7 to 25 6/7 weeks gestation) account for a small percentage of births but a disproportionate number of neonatal and infant deaths.
Decisions surrounding periviable births involve complex ethical considerations for families and healthcare teams.
Outcomes are influenced by gestational age, fetal factors, and antepartum, intrapartum, and postnatal management.

Purpose of the Study:

To describe newborn outcomes following periviable birth.
To provide current evidence and recommendations for interventions in periviable settings.
To offer guidance for family counseling, integrating patient preferences into decision-making.

Main Methods:

Review of factors associated with short-term and long-term outcomes.
Analysis of antepartum, intrapartum, and postnatal management options.
Development of a framework for family counseling and shared decision-making.

Main Results:

Gestational age, fetal sex, weight, plurality, delivery location, and interventions (antenatal corticosteroids, magnesium sulfate, intensive care) impact outcomes.
Management strategies include tocolysis, antibiotics, and delivery methods (cesarean).
Care should ideally occur in specialized centers with comprehensive maternal and neonatal expertise.

Conclusions:

Informed decision-making for periviable births requires understanding influencing factors and available interventions.
Family counseling should prioritize individual circumstances and patient values.
Recommendations support shared decision-making regarding acceptance or decline of interventions.