This is an executive summary of a workshop on the management and counseling issues
of women anticipated to deliver at a periviable gestation (broadly defined as 20 0/7
through 25 6/7 weeks of gestation) and the treatment options for the newborn infant.
Upon review of the available literature, the workshop panel noted that the rates of
neonatal survival and neurodevelopmental disabilities among the survivors vary greatly
across the periviable gestations and are significantly influenced by the obstetric
and neonatal management practices (eg, antenatal steroid, tocolytic agents, and antibiotic
administration; cesarean birth; and local protocols for perinatal care, neonatal resuscitation,
and intensive care support). These are, in turn, influenced by the variations in local
and regional definitions of limits of viability. Because of the complexities in making
difficult management decisions, obstetric and neonatal teams should confer prior to
meeting with the family, when feasible. Family counseling should be coordinated with
the goal of creating mutual trust, respect, and understanding and should incorporate
evidence-based counseling methods. Since clinical circumstances can change rapidly
with increasing gestational age, counseling should include discussion of the benefits
and risks of various maternal and neonatal interventions at the time of counseling.
There should be a plan for follow-up counseling as clinical circumstances evolve.
The panel proposed a research agenda and recommended developing educational curricula
on the care and counseling of families facing the birth of a periviable infant.
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Article Info
Publication History
Published online: April 10, 2014
Accepted:
February 25,
2014
Received:
February 25,
2014
Footnotes
This is an executive summary of a Society for Maternal-Fetal Medicine (SMFM), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), American College of Obstetricians and Gynecologists (the College), and American Academy of Pediatricians (AAP) Workshop that was held Feb. 12-13, 2013, in San Francisco, CA. The information and guidance herein reflects consensus regarding clinical and scientific advances as of the Workshop, is subject to change, and should not be construed as dictating an exclusive course of treatment or procedure. The information and guidance provided does not necessarily represent the official views of the National Institutes of Health, SMFM, NICHD, the College, or AAP, or the views of each individual participant in the Workshop.
This article is being published concurrently in the May 2014 issue (Vol. 123, No. 5) of Obstetrics & Gynecology and the May 2014 issue (Vol. 34, No. 5) of the Journal of Perinatology.
The authors did not report any potential conflicts of interest.
For a list of organizers, invited speakers, and discussants who participated in the workshop, see the Appendix online at http://links.lww.com/A483.
Identification
Copyright
© 2014 American College of Obstetricians and Gynecologists. Published by Elsevier Inc. All rights reserved.
