Perinatal Care and Threshold of Viability; A Great Dilemma

Abstract

Premature babies born at 21 weeks gestation or earlier have a very poor chance to survive. Babies born between 22 and 24 weeks gestation, may be able to be supported with intensive care, but have a high risk of dying despite treatment or permanent impairment in survivors. This period is sometimes referred to as the “threshold of viability”. For infants born around the threshold it may be appropriate to provide only comfort care after birth, to provide full intensive care support, or to provide a trial of treatment with management adjusted to the response to resuscitation and intensive care. Periviability is the earliest stage of fetal maturity where there is a reasonable chance of extrauterine survival. This period is generally between 22 and <26 weeks gestational age. Most infants born at ≥26 weeks gestational ages have a high chance of survival. Where there is a possibility of preterm labor around the threshold of viability, expert obstetric and neonatal teams should be consulted. Where possible and safe, early transfer of the mother should be arranged to a center with tertiary level neonatal care. At least 2 expert neonatologists should be present at the birth of any infant around the threshold of viability whether or not active resuscitation is planned. The obstetric and neonatal decision-making is derived from local and national consensus statements.