Gestation-Based Viability–Difficult Decisions with Far-Reaching Consequences

Abstract

Most clinicians rely on outcome data based on completed weeks of gestational of fetal maturity for antenatal and postnatal counseling, especially for preterm infants born at the margins of viability. Contemporary estimation of gestational maturity, based on ultrasounds, relies on the use of first-trimester scans, which offer an accuracy of ±3–7 days, and depend on the timing of the scans and the measurements used in the calculations. Most published literature on the outcomes of babies born prematurely have reported on short- and long-term outcomes based on completed gestational weeks of fetal maturity at birth. These outcome data change significantly from one week to the next, especially around the margin of gestational viability. With a change in approach solely from decisions based on survival, to disability-free survival and long-term functional outcomes, the complexity of the parental and care provider’s decision-making in the perinatal and postnatal period for babies born at less than 25 weeks gestation remains challenging. While sustaining life following birth at the margins of viability remains our priority—identifying and mitigating risks associated with extremely preterm birth begins in the perinatal period. The challenge of supporting the normal maturation of these babies postnatally has far-reaching consequences and depends on our ability to sustain life while optimizing growth, nutrition, and the repair of organs compromised by the consequences of preterm birth. This article aims to explore the ethical and medical complexities of contemporary decision-making in the perinatal and postnatal periods. We identify gaps in our current knowledge of this topic and suggest areas for future research, while offering a perspective for future collaborative decision-making and care for babies born at the margins of viability.

Acute appendicitis in pregnancy — do we treat correctly, or do we delay unnecessarily?

“…Basic demographic (age and American Society of Anesthesiologists [ASA] classification) and clinical data were observed and subsequently evaluated. Patients were divided into 2 subgroups according to the stage of pregnancy in relation to predicted foetal viability [14]. Viability is defined as the ability of the human foetus to survive outside the uterus.…”

Nutrition Support Practices for Infants Born <750 Grams or <25 Weeks Gestation: A Call for More Research

“…With advances in medical care and efforts to care for continually smaller and younger preterm infants, the gestational age of viability has decreased, including as young as 21 or 22 weeks of gestation [ 1 ]. While many extremely preterm infants (born <28 weeks gestation) [ 2 ] may be considered extremely low birth weight (ELBW, <1000 g), those born at the youngest ages often fall into the subcategory of “micropremie” (<750 g).…”

Optimizing Care for the Preterm Infant

“…The care of the small and very vulnerable preterm infant continues to be challenging and requires consistent review and study [ 9 , 10 , 11 , 12 , 13 , 14 ].…”