Limits of fetal viability and its repercussions on obstetric management

Purpose: The purpose of this study was to evaluate the outcome of infants b orn between 22 and 28 completed weeks of gestational age. A gestational age of 24 weeks, regarded in the relevant literature as the limit of viability , was the focus of particular interest. Study Design: Prenatal data were collected retrospectively from the materna l records. Neonatal mortality, early morbidity, as well as the disability r ate in the first year of follow-up at corrected age of prematurity were det ermined and correlated with gestational age. Results: 60 infants were included in the study. Intact survival improved wi th increasing gestational age. None of the infants born prior to 24 weeks s howed intact survival until discharge compared to 74 % of the infants born at 24 weeks or later. Gestational age had a major influence on severe handi cap (p < 0.03). 50 % of the infants prior 24 weeks showed a severe handicap compared to 24 % at 24 weeks or older. There was a marked improvement in t he outcome at 25 weeks of gestation (p < 0.01). Conclusion: Viability of fetuses at 23 and 24 weeks of gestation remains et hically and clinically controversial. In our opinion, fetuses at 23 weeks o r younger should not be considered viable at this time. On the other hand w e continue to treat fetuses at 24 weeks or older as viable. Aggressive obst etric management, especially Caesarean section, should nevertheless only be considered from a gestational age of 25 weeks onward.