Premium
The Obstetrician and the Extremely Immature Fetus (24–26 weeks): Outcome to 5 Years of Age
Author(s) -
Doyle Lex W.,
Permezel Michael,
Ford Geoffrey W.,
Knoches Annette M.L.,
Rickards Anne L.,
Kelly Elaine A.,
Cailanan Catherine
Publication year - 1994
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1994.tb01261.x
Subject(s) - medicine , gestational age , confidence interval , fetus , odds ratio , obstetrics , pregnancy , pediatrics , obstetrics and gynaecology , genetics , biology
Summary: 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 viewpoint, and to determine if their outcome has improved over time. Consecutive fetuses with gestational ages from 24–26 weeks born at the Royal Women'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 malformations or clearly dead before the onset of labour were excluded. The stillbirth rates were similar in both eras (Era 123.7%, 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%, X 2 = 5.0, p<0.03; odds ratio 1.80; 95% confidence interval [CI] 1.07 to 3.04). Overall, both the proportion and the absolute number of severely disabled children fell over time; 4 children survived with severe sensorineural disability in the 5¼ years of Era 1, but only one child in the 3 years of Era 2. From the obstetric viewpoint, only 1.5% of total births survived with a severe sensorineural disability, no higher than the rate expected for children born at term. Fetuses born at 24–26 weeks of gestational age need not contribute disproportionately to the number of severely disabled children in the community; furthermore, their outcome is improving over time. From the obstetrician's viewpoint, survival chances rather than sensorineural outcome should dominate decision‐making at these extremely preterm gestations.