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 (for example, 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.
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The authors declare no conflict of interest.
This is an executive summary of a Society for Maternal-Fetal Medicine, Eunice Kennedy Shriver National Institute of Child Health and Human Development, American College of Obstetricians and Gynecologists and American Academy of Pediatricians Workshop that was held 12–13 February 2013 in San Francisco, CA, USA. This article is being published concurrently in the May 2014 issue (vol. 123, no. 5) of Obstetrics & Gynecology and the May 2014 issue (vol. 210, no. 5) of the American Journal of Obstetrics and Gynecology.
The information and guidance herein reflect 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, Society for Maternal-Fetal Medicine, National Institute of Child Health and Human Development, the American College of Obstetricians and Gynecologists, or the American Academy of Pediatricians, 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.
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Raju, T., Mercer, B., Burchfield, D. et al. 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. J Perinatol 34, 333–342 (2014). https://doi.org/10.1038/jp.2014.70
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