The limit of viability--neonatal outcome of infants born at 22 to 25 weeks' gestation.

Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.
New England Journal of Medicine (Impact Factor: 54.42). 12/1993; 329(22):1597-601. DOI: 10.1056/NEJM199311253292201
Source: PubMed

ABSTRACT With improved survival of preterm infants, questions have been raised about the limit of viability. To provide better information and counseling for parents of infants about to be delivered after 22 to 25 weeks' gestation, we evaluated the mortality and neonatal morbidity of preterm infants born at these gestational ages.
We studied retrospectively all 142 infants born at 22 to 25 weeks' gestation (as judged by best obstetrical estimate) from May 1988 through September 1991 in a single hospital. Mortality in the first six months, including stillbirths, and neonatal morbidity (i.e., the presence of intracranial pathologic conditions, chronic lung disease, and retinopathy of prematurity) were analyzed.
Fifty-six infants (39 percent) survived for six months. Survival improved with increasing gestational age; none of 29 infants born at 22 weeks' gestation survived, as compared with 6 of 40 (15 percent) born at 23 weeks, 19 of 34 (56 percent) born at 24 weeks, and 31 of 39 (79 percent) born at 25 weeks. There were seven stillbirths at 22 weeks' gestation and four stillbirths at 23 weeks. The more immature the infant, the higher the incidence of neonatal complications as determined by the number of days of mechanical ventilation, the length of the hospital stay, and the presence of retinopathy of prematurity, periventricular or intraventricular hemorrhage, or periventricular leukomalacia. Only 2 percent of infants born at 23 weeks' gestation survived without severe abnormalities on cranial ultrasonography, as compared with 21 percent of those born at 24 weeks and 69 percent of those born at 25 weeks.
We believe that aggressive resuscitation of infants born at 25 weeks' gestation is indicated, but not of those born at 22 weeks. Whether the occasional child who is born at 23 or 24 weeks' gestation and does well justifies the considerable mortality and morbidity of the majority is a question that should be discussed by parents, health care providers, and society.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: In Nigeria, the age of fetal viability is defined as fetus that have achieved at least 28 weeks of gestation in utero, while World Health Organization (WHO) has reduced this age to 24 weeks gestation. By implication, delivery prior to 28 weeks gestation is regarded as abortion. There is therefore an urgent need to review this age old criteria for standard of care in Nigeria. Case presentation: A 27-year old G2P0 + 1 Nigerian Igbo woman, with no living child. She had previous pregnancy loss due to cervical incompetence and had cervical cerclage inserted at 14 weeks gestation in the index pregnancy. The pregnancy subsequently remained uneventful until at 26 weeks 5 days gestation when she had pre-viable pre-labour rupture of membranes with breech presentation. Conservative approach was adopted following counseling until thirty six hours later, when she had cord prolapse with live pre-viable fetus (inevitable abortion). The dilemma was to manage the woman as cord prolapse with live fetus and attempt to salvage the fetus or to manage as inevitable abortion and allow for spontaneous expulsion of the fetus. She subsequently had emergency hysterotomy with a delivery of live male baby with good APGAR score. The birth weight was 1.03 kg. He was discharged at the 10th week of life at a weight of 1.9 kg with no developmental deficit. Conclusion: We recommend the re-definition of the age of fetal viability in Nigeria considering the improvement in facilities to agree with WHO recommendation of 24 weeks gestation. Keywords Re-definition; Age of fetal viability; Inevitable abortion; 28 weeks gestation; 24 weeks gestation; World Health Organization
    Journal of Women Health, Issues and Care. 07/2014; 3(3):1-4.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Cardiopulmonary arrest is a rare event during pregnancy and labor. Perimortem cesarean section has been resorted to as a rare event since ancient times; however, greater awareness regarding this procedure within the medical community has only emerged in the past few decades. Current recommendations for maternal resuscitation include performance of the procedure following five minutes of unsuccessful cardiopulmonary resuscitation. If accomplished in a timely manner, perimortem cesarean section can result in fetal salvage and is also critical for maternal resuscitation. Nevertheless, knowledge deficits are common. We have reviewed publications on perimortem cesarean section and present the most recent evidence on this topic, as well as recommending our “easy-to-access protocol” adapted for resuscitation following maternal collapse.This article is protected by copyright. All rights reserved.
    Acta Obstetricia Et Gynecologica Scandinavica 07/2014; · 1.85 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Human institutions are so imperfect by their nature that in order to destroy them it is almost always enough to extend their underlying ideas to the extreme.
    Paediatric and Perinatal Epidemiology 01/1996; 10(1). · 2.16 Impact Factor