Management of Impending Periviable Delivery

Abstract

To review the role of obstetric interventions, the evidence behind these interventions, and the importance of offering these interventions to women and their families as they make decisions on whether to provide active neonatal management. Outcomes for infants born at periviability are improving with advancing neonatal care and management. Obstetric interventions play a role in helping to improve these outcomes. Administration of antenatal corticosteroids and magnesium sulfate should be considered if delivery is suspected. Cesarean delivery should be offered in cases of malpresentation or for other obstetric indications, with appropriate discussion around the associated maternal risks. Delayed cord clamping is considered beneficial and should be applied whenever possible. When active management is considered, or if further discussion is required, transfer to an advanced level NICU should be facilitated if possible. Obstetric management in the setting of an impending periviable delivery can have profound effects on neonatal outcomes. More research into what kind of impact these interventions have on outcomes is necessary. Until then, individualized counseling, shared decision-making, and interdisciplinary involvement are all needed to ensure women and families make as informed a decision as possible.