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. 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.
A workshop on the management and counseling issues of women anticipated to deliver at a periviable gestation reviews the outcomes, benefits, and risks of obstetric and neonatal interventions and provides an outline for counseling regarding periviable birth.Supplemental Digital Content is Available in the Text.
Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; the Society for Maternal-Fetal Medicine and Case Western Reserve University–MetroHealth Medical Center, Cleveland, Ohio; the American Academy of Pediatrics and University of Florida, Gainesville, Florida; and the American College of Obstetricians and Gynecologists, Washington, DC.
Corresponding author: Brian M. Mercer, MD, Department of Obstetrics and Gynecology, Suite G267, 2500 MetroHealth Drive, MetroHealth Medical Center, Cleveland, Ohio 44109; e-mail: firstname.lastname@example.org.
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 February 12–13, 2013, in San Francisco, California. 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.
For a list of organizers, invited speakers, and discussants who participated in the workshop, see the Appendix online at http://links.lww.com/AOG/A483.
This article is being published concurrently in the May 2014 issue (Vol. 210, No. 5) of the American Journal of Obstetrics and Gynecology and the May 2014 issue (Vol. 34, No. 5) of the Journal of Perinatology.
Financial Disclosure The authors did not report any potential conflicts of interest.