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DOI: 10.1055/a-1815-2000
Patient Decisions Regarding Fetal Monitoring in the Periviable Period and Perinatal and Maternal Outcomes
Funding None.![](https://www.thieme-connect.de/media/ajp/202213/lookinside/thumbnails/10-1055-a-1815-2000_210474-1.jpg)
Abstract
Objective Management of delivery at periviable gestation requires complex counseling and decision making, including difficult choices about monitoring and potential cesarean delivery (CD) for fetal benefit. Our objective was to characterize decisions that patients make regarding fetal monitoring and potential CD for fetal benefit when delivering in the periviable period, and associations with perinatal and obstetric outcomes. We hypothesize that a significant number of patients forgo monitoring and potential CD for fetal benefit in the periviable period when offered the opportunity to do so.
Study Design Retrospective cohort study of nonanomalous singleton pregnancies delivering between 230/7 and 256/7 weeks at a tertiary care center from 2015 to 2020 as based on our institutional clinical practice. Since 2015, these patients are offered the ability to accept or decline fetal monitoring, potential CD for fetal benefit, and active resuscitation of a liveborn neonate. The frequency of patients desiring potential CD for fetal benefit was identified, and associations with CD and intrapartum demise were analyzed.
Results Fifty subjects were included. Seventy-eight percent (n = 39) desired monitoring and potential CD for fetal benefit, and 84% (n = 42) desired resuscitation if the neonate was born alive. This varied by gestational age: 55% (6/11) of patients delivering between 230/7 and 236/7 weeks desired fetal monitoring and potential CD for fetal benefit, while 90% (19/21) of patients delivering between 250/7 and 256/7 weeks desired fetal monitoring and potential CD for fetal benefit (p = 0.02). Sixty-nine percent of pregnancies in which potential CD for fetal benefit was desired resulted in CD (27/39), of which 85% were classical (23/27). Intrapartum fetal demise occurred in 45% (5/11) of pregnancies in which monitoring was not performed.
Conclusion While a majority of patients delivering between 230/7 and 256/7 weeks desired monitoring and potential CD for fetal benefit, this varied significantly by gestational age. The decision to perform monitoring and potential CD for fetal benefit was associated with a high frequency of CD, while the decision to forgo monitoring was associated with high frequency of intrapartum demise.
Key Points
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Patients desires vary in the setting of periviable delivery.
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Periviable monitoring is associated with cesarean delivery.
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Forgoing monitoring is associated with intrapartum demise.
Keywords
periviable delivery - periviability counseling - fetal monitoring - cesarean delivery - intrapartum fetal demiseNote
This paper was presented in poster format at the 41st Annual Pregnancy Meeting of the Society of Maternal-Fetal Medicine in January 2021.
Publikationsverlauf
Eingereicht: 18. Juni 2021
Angenommen: 28. März 2022
Accepted Manuscript online:
01. April 2022
Artikel online veröffentlicht:
06. Juni 2022
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References
- 1 Younge N, Goldstein RF, Bann CM. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Survival and neurodevelopmental outcomes among periviable infants. N Engl J Med 2017; 376 (07) 617-628
- 2 Myrhaug HT, Brurberg KG, Hov L, Markestad T. Survival and impairment of extremely premature infants: a meta-analysis. Pediatrics 2019; 143 (02) e20180933
- 3 Patel RM, Rysavy MA, Bell EF, Tyson JE. Survival of infants born at periviable gestational ages. Clin Perinatol 2017; 44 (02) 287-303
- 4 Adams-Chapman I, Heyne RJ, DeMauro SB. et al; Follow-Up Study of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Neurodevelopmental impairment among extremely preterm infants in the Neonatal Research Network. Pediatrics 2018; 141 (05) e20173091
- 5 Marlow N, Wolke D, Bracewell MA, Samara M. EPICure Study Group. Neurologic and developmental disability at six years of age after extremely preterm birth. N Engl J Med 2005; 352 (01) 9-19
- 6 American College of Obstetricians & Gynecologists, Society for Maternal-Fetal Medicine. ACOG Obstetric Care Consensus no. 6: Periviable birth. Obstet Gynecol 2017; Oct; 130 (04) e187-e199
- 7 Kawakita T, Sondheimer T, Jelin A. et al. Maternal morbidity by attempted route of delivery in periviable birth. J Matern Fetal Neonatal Med 2021; 34 (08) 1241-1248
- 8 Reddy UM, Rice MM, Grobman WA. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Serious maternal complications after early preterm delivery (24–33 weeks' gestation). Am J Obstet Gynecol 2015; 213 (04) 538.e1-538.e9
- 9 Lannon SMR, Guthrie KA, Reed SD, Gammill HS. Mode of delivery at periviable gestational ages: impact on subsequent reproductive outcomes. J Perinat Med 2013; 41 (06) 691-697
- 10 Lannon SMR, Guthrie KA, Vanderhoeven JP, Gammill HS. Uterine rupture risk after periviable cesarean delivery. Obstet Gynecol 2015; 125 (05) 1095-1100
- 11 Rossi RM, DeFranco EA. Maternal complications associated with periviable birth. Obstet Gynecol 2018; 132 (01) 107-114
- 12 Romagano MP, Fofah O, Apuzzio JJ, Williams SF, Gittens-Williams L. Maternal morbidity after early preterm delivery (23–28 weeks). Am J Obstet Gynecol MFM 2020; 2 (03) 100125
- 13 Stoll BJ, Hansen NI, Bell EF. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Trends in care practices, morbidity, and mortality of extremely premature neonates, 1993–2012. JAMA 2015; 314 (10) 1039-1051
- 14 Tucker Edmonds B, Hoffman SM, Laitano T, Jeffries E, Jager S, Kavanaugh K. Diverse perspectives on death, disability, and quality of life: an exploratory study of racial differences in periviable decision-making. J Perinatol 2021; 41 (03) 396-403
- 15 Tucker Edmonds B, Savage TA, Kimura RE. et al. Prospective parents' perspectives on antenatal decision making for the anticipated birth of a periviable infant. J Matern Fetal Neonatal Med 2019; 32 (05) 820-825
- 16 Executive order on protecting vulnerable newborn and infant children. September 25, 2020