Lw. Doyle et al., THE OBSTETRICIAN AND THE EXTREMELY IMMATURE FETUS (24-26 WEEKS) - OUTCOME TO 5 YEARS OF AGE, Australian and New Zealand Journal of Obstetrics and Gynaecology, 34(4), 1994, pp. 421-424
The aims of this study were to determine the outcome to 5 years of age
for fetuses 24-26 weeks of gestational age from the obstetric viewpoi
nt, and to determine if their outcome has improved over time. Consecut
ive fetuses with gestational ages from 24-26 weeks born at the Royal W
omen's Hospital, Melbourne, during 2 separate eras, Era 1 (1977-1982;
n = 198) and Era 2 (1985-1987; n = 128) were studied and their outcome
to 5 years of age determined. Fetuses referred with lethal malformati
ons or clearly dead before the onset of labour were excluded. The stil
lbirth rates were similar in both eras (Era 1 23.7%, Era 2 21.9%), but
the proportion of survivors to 5 years of age was much higher in Era
2 (Era 1 19.7%, Era 2 30.5%, X2 = 5.0, p<0.03; odds ratio 1.80; 95% co
nfidence interval [CI] 1.07 to 3.04). Overall, both the proportion and
the absolute number of severely disabled children fell over time; 4 c
hildren survived with severe sensorineural disability in the 5 1/4 yea
rs of Era 1, but only one child in the 3 years of Era 2. From the obst
etric viewpoint, only 1.5% of total births survived with a severe sens
orineural disability, no higher than the rate expected for children bo
rn at term. Fetuses born at 24-26 weeks of gestational age need not co
ntribute disproportionately to the number of severely disabled childre
n in the community; furthermore, their outcome is improving over time.
From the obstetrician's viewpoint, survival chances rather than senso
rineural outcome should dominate decision-making at these extremely pr
eterm gestations.