Abstract 1425 Poster Session III, Monday, 5/3 (poster 34)

The potential for survival and good outcome for pregnancies presenting in labor at 22 to 25 weeks remains a concern for perinatologists, neonatologists and parents. Most reports present neonatal survival data. The purpose of this study was to determine the survival and major neonatal morbidity rates for all pregnancies presenting in labor and delivering at 22-25 wks gestation between January 93 and December 97. Study outcomes were fetal deaths, neonatal survival and major neonatal morbidities including intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), retinopathy of prematurity (ROP) and days of hospitalization (DOH). (Table) The risk of both fetal death during labor and neonatal death increased significantly with decreasing gestation. Although survival at 23-25 wks is improved, the risk of neonatal complications remains high. Analyses of time effects between 1993 and 1997 revealed survival at 22-25 wks remained fairly constant at 67%. All major neonatal morbidities were inversely related to gestation. Multivariate analyses were run to determine the factors associated with neonatal survival. Gestational age, birthweight, gender, antenatal steroids, surfactant and C-section were entered. Results showed that ↑ gestational age (p<0.0002) ↑ bwt (p<0.001), and female gender (p<0.004) were associated with ↑ survival. C-section was associated with ↓ survival (p<0.006) and prenatal steroids did not contribute to the model. We conclude that the probability of survival remains dismal at 22 wks and prenatal steroids do not impact on survival in pregnancies at 22-25 wks. The risk of neonatal morbidities remains high and is inversely related to gestation.

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