Neonatal Resuscitation in 22-Week Pregnancies

Abstract

(N Engl J Med. 2022;386:391–393) A case vignette is presented to highlight contrasting approaches to the imminent delivery of a 22-week neonate. A 20-year-old, gravida 2 pregnant woman presented at the emergency department with symptoms of premature labor. Her first child was born at 34 weeks by spontaneous vaginal delivery and is a healthy 2-year-old. This parturient has no chronic medical conditions and is receiving routine prenatal care. Her prenatal ultrasonography showed no fetal or placental irregularities. Her vital signs were normal and physical exam is notable only for her active pregnancy. On cervical exam, 3 cm dilation, 40% effacement, and a −2 fetal station. Clinicians are invited to reflect on 2 scenarios regarding whether (1) resuscitation should be recommended for all 22-week neonates; or (2) resuscitation should be offered selectively for 22-week neonates, with opinions offered by experts in favor of positions assigned by the editor.