Periviable birth: executive summary of a joint workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Academy of Pediatrics, and American College of Obstetricians and Gynecologists

Raju, Tonse N.K.; Mercer, Brian M.; Burchfield, David J.; Joseph, Gerald F.

doi:10.1016/j.ajog.2014.02.027

Cited by 109 publications

(106 citation statements)

References 55 publications

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“…International statements guide clinicians on antenatal counselling and perinatal management at peri-viable gestations. 3,6,7 Principles within these statements are consistent with the approach taken in NZ and Australia.…”

Section: Introductionsupporting

confidence: 73%

“…1 Although few babies are born at peri-viable gestations (defined here as 23 +0 -24 +6 weeks), they have the highest rates of mortality and morbidity. 2,3 Many factors impact on the rates of survival and survival-free of major morbidity but local hospital practice regarding the offer of resuscitation (active intervention) is the most significant factor at these very preterm gestations. 4 Inequities in care for babies born at peri-viable gestations have been reported.…”

Section: Introductionmentioning

confidence: 99%

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Perinatal care provided for babies born at 23 and 24 weeks of gestation

Dawes

Buksh

Sadler

et al. 2019

Aust NZ J Obst Gynaeco

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In recent years, significant improvements in survival and survival‐free of major morbidity in babies born at 23+0 to 24+6 weeks of gestation have led to a more pro‐active approach to resuscitation at these peri‐viable gestations. Antenatal counselling and interventions, intrapartum care and postnatal advice should be part of the package of care provided to optimise outcomes for these babies and their families. This observational study assesses the perinatal care provided to mothers and their babies who were born at 23 and 24 weeks of gestations over a two‐year period at a tertiary maternity hospital in New Zealand.

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Section: Introductionsupporting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Perinatal care provided for babies born at 23 and 24 weeks of gestation

Dawes

Buksh

Sadler

et al. 2019

Aust NZ J Obst Gynaeco

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“…23–25 All infants in this study were delivered in academic centers with availability of tertiary maternal fetal medicine and comprehensive neonatal care. Changes in race/ethnicity likely reflect changes in the centers in the NRN over time and changes in populations served.…”

Section: Discussionmentioning

confidence: 99%

Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993-2012

Stoll

Hansen

Bell

et al. 2015

JAMA

2,186

1,357

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Importance Extremely preterm infants contribute disproportionately to neonatal morbidity and mortality. Objective To review 20-year trends in maternal/neonatal care, complications, and mortality among extremely preterm infants born at Neonatal Research Network centers. Design, Setting, Participants Prospective registry of 34,636 infants 22–28 weeks’ gestational age (GA) and 401–1500 gram birthweight born at 26 Network centers, 1993–2012. Exposure Extremely preterm birth. Main Outcomes Maternal/neonatal care, morbidities, and survival. Major morbidities, reported for infants who survived more than 12 hours, were: severe necrotizing enterocolitis, infection, bronchopulmonary dysplasia, severe intracranial hemorrhage, cystic periventricular leukomalacia, and/or severe retinopathy of prematurity. Regression models assessed yearly changes, adjusting for study center, race/ethnicity, GA, birthweight for GA, and sex. Results Use of antenatal corticosteroids increased from 1993 to 2012 (348/1431 [24%] to 1674/1919 [87%], p<0.001), as did cesarean delivery (625/1431 [44%] to 1227/1921 [64%], p<0.001). Delivery room intubation decreased from 1144/1433 (80%) in 1993 to 1253/1922 (65%) in 2012 (p<0.001). After increasing in the 1990s, postnatal steroid use declined to 141/1757 (8%) in 2004 (p<0.001), with no significant change thereafter. Although most infants were ventilated, continuous positive airway pressure without ventilation increased from 120/1666 (7%) in 2002 to 190/1756 (11%) in 2012 (p<0.001). Despite no improvement from 1993 to 2004, rates of late-onset sepsis declined between 2005 and 2012 for infants of each GA (median GA 26 weeks, 109/296 [37%] to 85/320 [27%], adjusted relative risk [aRR]: 0.93 [95% CI, 0.92–0.94]). Rates of other morbidities declined, but bronchopulmonary dysplasia increased between 2009 and 2012 for infants 26–27 weeks (26 weeks, 130/258 [50%] to 164/297 [55%], p<0.001). Survival increased between 2009 and 2012 for infants 23 weeks (41/152 [27%] to 50/150 [33%], aRR: 1.09 [95% CI, 1.05–1.14]) and 24 weeks (156/248 [63%] to 174/269 [65%], aRR: 1.05 [95% CI, 1.03–1.07]), with smaller relative increases for infants 25 and 27 weeks and no change for infants 22, 26 and 28 weeks. Survival without major morbidity increased approximately 2% per year for infants 25–28 weeks with no change for infants 22–24 weeks. Conclusions and Relevance Among extremely preterm infants born at US academic centers over the last 20 years, changes in maternal and infant care practices and modest reductions in several morbidities were observed, although bronchopulmonary dysplasia increased. Survival increased most markedly for infants born at 23 and 24 weeks and survival without major morbidity increased for infants 25–28 weeks. These findings may be valuable in counselling families and developing novel interventions.

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“…However, there is a paucity of data on maternal morbidity associated with early preterm delivery and in fact this has been identified as a key area requiring further research. 3 Classical cesarean delivery has been associated with an increased risk of uterine rupture and uterine scar dehiscence in subsequent pregnancies 4,5 and, in some studies, with an increased risk of acute complications such as hemorrhage and infection. 6–10 Several mostly small studies have evaluated the relationship of preterm delivery (including variation across gestational age) and route of delivery to postpartum maternal morbidity.…”

Section: Introductionmentioning

confidence: 99%

Serious maternal complications after early preterm delivery (24-33 weeks’ gestation)

Reddy

Rice

Grobman

et al. 2015

American Journal of Obstetrics and Gynecology

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OBJECTIVE To describe the prevalence of serious maternal complications following early preterm birth by gestational age (GA), delivery route and type of cesarean incision. STUDY DESIGN Trained personnel abstracted data from maternal and neonatal charts for all deliveries on randomly selected days representing 1/3 of deliveries across 25 US hospitals over 3 years (n=115,502). All women delivering non-anomalous singletons between 23 and 33 weeks’ gestation were included. Women were excluded for antepartum stillbirth and highly morbid conditions for which route of delivery would not likely impact morbidity including non-reassuring fetal status, cord prolapse, placenta previa, placenta accreta, placental abruption, and severe, unstable maternal conditions (cardiopulmonary collapse, acute respiratory distress syndrome, seizures). Serious maternal complications were defined as: hemorrhage (blood loss ≥1500 mL, blood transfusion, or hysterectomy for hemorrhage); infection (endometritis, wound dehiscence, or wound infection requiring antibiotics, reopening or unexpected procedure); ICU admission; or death. Delivery route was categorized as classical cesarean delivery (CCD), low transverse cesarean delivery (LTCD), low vertical cesarean delivery (LVCD), and vaginal delivery (VD). Association of delivery route with complications was estimated using multivariable regression models yielding adjusted relative risks (aRR) controlling for maternal age, race, body mass index, hypertension, diabetes, preterm premature rupture of membranes, preterm labor, GA, and hospital of delivery. RESULTS Of 2659 women who met criteria for inclusion in this analysis, 8.6% of women experienced serious maternal complications. Complications were associated with GA and were highest between 23–27 weeks of gestation. The frequency of complications was associated with delivery route; compared with 3.5% of SVD, 23.0% of CCD (aRR 3.54, 95%CI 2.29–5.48), 12.1% of LTCD (aRR 2.59, 95%CI 1.77–3.77), and 10.3% of LVCD (aRR 2.27, 95%CI 0.68–7.55) experienced complications. There was no significant difference in complication rates between CCD and LTCD (aRR 1.37, 95%CI 0.95–1.97) or between CCD and LVCD (aRR 1.56, 95%CI 0.48–5.07). CONCLUSION The risk of maternal complications after early preterm delivery is substantial, particularly in women who undergo cesarean delivery. Obstetricians need to be prepared to manage potential hemorrhage, infection and ICU admission for early preterm births requiring cesarean delivery.

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Periviable birth: executive summary of a joint workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Academy of Pediatrics, and American College of Obstetricians and Gynecologists

Cited by 109 publications

References 55 publications

Perinatal care provided for babies born at 23 and 24 weeks of gestation

Perinatal care provided for babies born at 23 and 24 weeks of gestation

Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993-2012

Serious maternal complications after early preterm delivery (24-33 weeks’ gestation)

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