.png){kind=icon}
返回
Periviable birth: Interim update
.png){kind=icon}
OA
AI
DOI：10.1016/j.ajog.2016.04.017.png)
.png){kind=icon}
原文求助.png){kind=icon}
分享.png){kind=icon}
收藏
摘要
En 中文
The information reflects emerging clinical and scientific advances as of the date issued, is subject to change, and should not be construed as dictating an exclusive course of treatment or procedure. Variations in practice may be warranted based on the needs of the individual patient, resources, and limitations unique to the institution or type of practice. Approximately 0.5% of all births occur before the third trimester of pregnancy, and these very early deliveries result in the majority of neonatal deaths and more than 40% of infant deaths. A recent executive summary of proceedings from a joint workshop defined periviable birth as delivery occurring from 20 0/7 weeks to 25 6/7 weeks of gestation. When delivery is anticipated near the limit of viability, families and health care teams are faced with complex and ethically challenging decisions. Multiple factors have been found to be associated with short-term and long-term outcomes of periviable births in addition to gestational age at birth. These include, but are not limited to, nonmodifiable factors (eg, fetal sex, weight, plurality), potentially modifiable antepartum and intrapartum factors (eg, location of delivery, intent to intervene by cesarean delivery or induction for delivery, administration of antenatal corticosteroids and magnesium sulfate), and postnatal management (eg, starting or withholding and continuing or withdrawing intensive care after birth). Antepartum and intrapartum management options vary depending upon the specific circumstances but may include short-term tocolytic therapy for preterm labor to allow time for administration of antenatal steroids, antibiotics to prolong latency after preterm premature rupture of membranes or for intrapartum group B streptococci prophylaxis, and delivery, including cesarean delivery, for concern regarding fetal well-being or fetal malpresentation. Whenever possible, periviable births for which maternal or neonatal intervention is planned should occur in centers that offer expertise in maternal and neonatal care and the needed infrastructure, including intensive care units, to support such services. This document describes newborn outcomes after periviable birth, provides current evidence and recommendations regarding interventions in this setting, and provides an outline for family counseling with the goal of incorporating informed patient preferences. Its intent is to provide support and guidance regarding decisions, including declining and accepting interventions and therapies, based on individual circumstances and patient values.
Keyword:
EXTREMELY PRETERM INFANTS
EXTREMELY PREMATURE-INFANTS
GESTATIONAL-AGE
CHILDREN BORN
NEURODEVELOPMENTAL OUTCOMES
ANTENATAL CORTICOSTEROIDS
DEVELOPMENTAL-DISABILITY
EMERGENCY CERCLAGE
BED REST
MORTALITY
期刊
IF:
8.4
论文数:
3.3W
被引数:
4.5W
机构
暂无机构信息
引用论文
Neonatal Outcomes of Extremely Preterm Infants From the NICHD Neonatal Research Network来自NICHD新生儿研究网络的极早产儿的新生儿结局.png)
PEDIATRICS
OAAI
PEDIATRICSIF6.4
OAAI分享收藏分享收藏
查看更多内容