PMID- 27214190
DCOM- 20170515
LR  - 20170515
IS  - 1873-233X (Electronic)
IS  - 0029-7844 (Linking)
VI  - 127
IP  - 6
DP  - 2016 Jun
TI  - Obstetric Care Consensus No. 4: Periviable Birth.
PG  - e157-69
LID - 10.1097/AOG.0000000000001483 [doi]
AB  - Approximately 0.5% of all births occur before the third trimester of pregnancy,
      and these very early deliveries result in the majority of neonatal deaths and
      more than 40% of infant deaths. A recent executive summary of proceedings from a 
      joint workshop defined periviable birth as delivery occurring from 20 0/7 weeks
      to 25 6/7 weeks of gestation. When delivery is anticipated near the limit of
      viability, families and health care teams are faced with complex and ethically
      challenging decisions. Multiple factors have been found to be associated with
      short-term and long-term outcomes of periviable births in addition to gestational
      age at birth. These include, but are not limited to, nonmodifiable factors (eg,
      fetal sex, weight, plurality), potentially modifiable antepartum and intrapartum 
      factors (eg, location of delivery, intent to intervene by cesarean delivery or
      induction for delivery, administration of antenatal corticosteroids and magnesium
      sulfate), and postnatal management (eg, starting or withholding and continuing or
      withdrawing intensive care after birth). Antepartum and intrapartum management
      options vary depending upon the specific circumstances but may include short-term
      tocolytic therapy for preterm labor to allow time for administration of antenatal
      steroids, antibiotics to prolong latency after preterm premature rupture of
      membranes or for intrapartum group B streptococci prophylaxis, and delivery,
      including cesarean delivery, for concern regarding fetal well-being or fetal
      malpresentation. Whenever possible, periviable births for which maternal or
      neonatal intervention is planned should occur in centers that offer expertise in 
      maternal and neonatal care and the needed infrastructure, including intensive
      care units, to support such services. This document describes newborn outcomes
      after periviable birth, provides current evidence and recommendations regarding
      interventions in this setting, and provides an outline for family counseling with
      the goal of incorporating informed patient preferences. Its intent is to provide 
      support and guidance regarding decisions, including declining and accepting
      interventions and therapies, based on individual circumstances and patient
LA  - eng
PT  - Consensus Development Conference
PT  - Journal Article
PL  - United States
TA  - Obstet Gynecol
JT  - Obstetrics and gynecology
JID - 0401101
SB  - IM
MH  - Female
MH  - Humans
MH  - *Infant, Extremely Premature
MH  - Infant, Newborn
MH  - Obstetrics/standards
MH  - Pregnancy
MH  - *Premature Birth
EDAT- 2016/05/24 06:00
MHDA- 2017/05/16 06:00
CRDT- 2016/05/24 06:00
PHST- 2016/05/24 06:00 [entrez]
PHST- 2016/05/24 06:00 [pubmed]
PHST- 2017/05/16 06:00 [medline]
AID - 10.1097/AOG.0000000000001483 [doi]
AID - 00006250-201606000-00043 [pii]
PST - ppublish
SO  - Obstet Gynecol. 2016 Jun;127(6):e157-69. doi: 10.1097/AOG.0000000000001483.