Considerations for obstetric management of births 22-25 weeks' gestation

Preterm birth between 22 and 25 5/7 weeks complicates <1% of live births within the United States though contributes more than 20% of infant mortality within the first year of life. Ante- and intrapartum interventions such as antenatal corticosteroids, magnesium sulfate, and tocolytic and antibiotic therapies have been shown effective in optimizing postnatal prognosis in births at 24 weeks and beyond. Interventions, mode of delivery, and resuscitation plans should ideally be discussed with the perinatology, neonatology, and nursing teams with the family using shared decision making. Observational data have alluded to similar postnatal benefits in births at 22-23 weeks; however, these data are limited by small sample sizes, inconsistencies in outcome reporting, and variations in management strategies. Future studies to evaluate the utility of these interventions among births at 22-23 weeks are warranted.