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DELIVERY AT THE LIMITS OF VIABILITY

Published online by Cambridge University Press:  12 September 2013

CATHERINE E. AIKEN
Affiliation:
Department of Fetal Medicine, The Rosie Hospital, Cambridge CB2 0QQ, UK.
JEREMY C. BROCKELSBY*
Affiliation:
Department of Fetal Medicine, The Rosie Hospital, Cambridge CB2 0QQ, UK.
*
Jeremy C Brockelsby, Department of Fetal Medicine, The Rosie Hospital, Cambridge CB2 0QQ, UK. Email: cema2@cam.ac.uk

Extract

Delivery of the infant at the limits of viability is a complex challenge for the obstetrician. Despite the best efforts of obstetricians to prolong gestation beyond 23–24 weeks, there may be compelling reasons to intervene in an ongoing pregnancy for maternal benefit (for example in severe pre-eclampsia or placental abruption) or delivery may be considered for foetal reasons. However, the majority of deliveries at the limits of viability will be the consequence of spontaneous pre-term labour, leaving the obstetrician with the difficult and time-pressured decisions regarding which, if any, interventions may be of benefit to foetal or maternal outcome. In most European countries, the rate of pre-term birth continues to rise, making such clinical scenarios increasingly common.

Type
Review Article
Copyright
Copyright © Cambridge University Press 2013 

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References

REFERENCES

1Zeitlin, J, Szamotulska, K, Drewniak, N, Mohangoo, A, Chalmers, J, Sakkeus, L, et al. Preterm birth time trends in Europe: a study of 19 countries. BJOG 2013 May 24 (published ahead of print).CrossRefGoogle Scholar
2Costeloe, KL, Hennessy, EM, Haider, S, Stacey, F, Marlow, N, Draper, ES. Short term outcomes after extreme preterm birth in England: comparison of two birth cohorts in 1995 and 2006 (the EPICure studies). BMJ 2012; 345: e7976.CrossRefGoogle ScholarPubMed
3Iams, JD, Romero, R, Culhane, JF, Goldenberg, RL. Primary, secondary, and tertiary interventions to reduce the morbidity and mortality of preterm birth. Lancet 2008 Jan 12; 371 (9607): 164–75.Google Scholar
4Moore, T, Hennessy, EM, Myles, J, Johnson, SJ, Draper, ES, Costeloe, KL, et al.Neurological and developmental outcome in extremely preterm children born in England in 1995 and 2006: the EPICure studies. BMJ 2012; 345: e7961.Google Scholar
5Chien, LY, Whyte, R, Aziz, K, Thiessen, P, Matthew, D, Lee, SK, et al.Improved outcome of preterm infants when delivered in tertiary care centers. Obstet Gynecol 2001 Aug; 98 (2): 247–52.Google ScholarPubMed
6Vento, M, Cheung, PY, Aguar, M. The first golden minutes of the extremely-low-gestational-age neonate: a gentle approach. Neonatology 2009; 95 (4): 286–98.CrossRefGoogle ScholarPubMed
7Roberts, D, Dalziel, S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2006; (3): CD004454.Google Scholar
8Tyson, JE, Parikh, NA, Langer, J, Green, C, Higgins, RD, National Institute of Child H, et al.Intensive care for extreme prematurity–moving beyond gestational age. N Engl J Med 2008 Apr 17; 358 (16): 1672–81.CrossRefGoogle ScholarPubMed
9Hayes, EJ, Paul, DA, Stahl, GE, Seibel-Seamon, J, Dysart, K, Leiby, BE, et al.Effect of antenatal corticosteroids on survival for neonates born at 23 weeks of gestation. Obstet Gynecol 2008 Apr; 111 (4): 921–6.Google Scholar
10Costeloe, K, Group EPS. EPICure: facts and figures: why preterm labour should be treated. BJOG 2006 Dec; 113 (Suppl. 3): 10–2.CrossRefGoogle Scholar
11Arad, I, Braunstein, R, Ergaz, Z, Peleg, O. Bruising at birth: antenatal associations and neonatal outcome of extremely low birth weight infants. Neonatology 2007; 92 (4): 258–63.Google Scholar
12Committee Opinion No. 455: Magnesium sulfate before anticipated preterm birth for neuroprotection. Obstet Gynecol 2010 Mar; 115 (3): 669–71.Google Scholar
13Douglas-Escobar, M, Weiss, MD. Biomarkers of brain injury in the premature infant. Front Neurol 2012; 3: 185.Google Scholar
14Doyle, LW, Crowther, CA, Middleton, P, Marret, S, Rouse, D. Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus. Cochrane Database Syst Rev 2009; (1): CD004661.Google Scholar
15Marret, S, Marpeau, L, Zupan-Simunek, V, Eurin, D, Leveque, C, Hellot, MF, et al.Magnesium sulphate given before very-preterm birth to protect infant brain: the randomised controlled PREMAG trial*. BJOG 2007 Mar; 114 (3): 310–8.CrossRefGoogle ScholarPubMed
16Rouse, DJ, Hirtz, DG, Thom, E, Varner, MW, Spong, CY, Mercer, BM, et al.A randomized, controlled trial of magnesium sulfate for the prevention of cerebral palsy. N Engl J Med 2008 Aug 28; 359 (9): 895905.Google Scholar
17Ghi, T, Maroni, E, Arcangeli, T, Alessandroni, R, Stella, M, Youssef, A, et al.Mode of delivery in the preterm gestation and maternal and neonatal outcome. J Matern Fetal Neonatal Med 2010 Dec; 23 (12): 1424–8.Google Scholar
18Riskin, A, Riskin-Mashiah, S, Lusky, A, Reichman, B, Israel Neonatal, N. The relationship between delivery mode and mortality in very low birthweight singleton vertex-presenting infants. BJOG 2004 Dec; 111 (12): 1365–71.Google Scholar
19Wylie, BJ, Davidson, LL, Batra, M, Reed, SD. Method of delivery and neonatal outcome in very low-birthweight vertex-presenting fetuses. Am J Obstet Gynecol 2008 Jun; 198 (6): 640.e17; discussion e1–4.Google Scholar
20Hogberg, U, Holmgren, PA. Infant mortality of very preterm infants by mode of delivery, institutional policies and maternal diagnosis. Acta Obstet Gynecol Scand 2007; 86 (6): 693700.Google Scholar
21Mukhopadhyay, A, Keriakos, R. Obstetric management and perinatal outcome of extreme prematurity: a retrospective study. J Obstet Gynaecol 2008 Feb; 28 (2): 185–8.Google Scholar
22Malloy, MH. Impact of cesarean section on neonatal mortality rates among very preterm infants in the United States, 2000–2003. Pediatrics 2008 Aug; 122 (2): 285–92.Google Scholar
23Bottoms, SF, Paul, RH, Iams, JD, Mercer, BM, Thom, EA, Roberts, JM, et al.Obstetric determinants of neonatal survival: influence of willingness to perform cesarean delivery on survival of extremely low-birth-weight infants. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Am J Obstet Gynecol 1997 May; 176 (5): 960–6.CrossRefGoogle ScholarPubMed
24Muhuri, PK, Macdorman, MF, Menacker, F. Method of delivery and neonatal mortality among very low birth weight infants in the United States. Matern Child Health J 2006 Jan; 10 (1): 4753.Google Scholar
25Deulofeut, R, Sola, A, Lee, B, Buchter, S, Rahman, M, Rogido, M. The impact of vaginal delivery in premature infants weighing less than 1,251 grams. Obstet Gynecol 2005 Mar; 105 (3): 525–31.Google Scholar
26Dani, C, Poggi, C, Bertini, G, Pratesi, S, Di Tommaso, M, Scarselli, G, et al.Method of delivery and intraventricular haemorrhage in extremely preterm infants. J Matern Fetal Neonatal Med 2010 Dec; 23 (12): 1419–23.Google Scholar
27Vimercati, A, Scioscia, M, Nardelli, C, Panella, E, Laforgia, N, Decosmo, L, et al.Are active labour and mode of delivery still a challenge for extremely low birth weight infants? Experience at a tertiary care hospital. Eur J Obstet Gynecol Reprod Biol 2009 Aug; 145 (2): 154–7.Google Scholar
28Wadhawan, R, Vohr, BR, Fanaroff, AA, Perritt, RL, Duara, S, Stoll, BJ, et al.Does labor influence neonatal and neurodevelopmental outcomes of extremely-low-birth-weight infants who are born by cesarean delivery? Am J Obstet Gynecol 2003 Aug; 189 (2): 501–6.CrossRefGoogle ScholarPubMed
29Haque, KN, Hayes, AM, Ahmed, Z, Wilde, R, Fong, CY. Caesarean or vaginal delivery for preterm very-low-birth weight (< or = 1,250 g) infant: experience from a district general hospital in UK. Arch Gynecol Obstet 2008 Mar; 277 (3): 207–12.Google Scholar
30Grant, A, Glazener, CM. Elective caesarean section versus expectant management for delivery of the small baby. Cochrane Database Syst Rev 2001; (2):CD000078.Google Scholar
31Drife, J. Mode of delivery in the early preterm infant (<28 weeks). BJOG 2006 Dec; 113 (Suppl. 3): 81–5.CrossRefGoogle Scholar
32Alfirevic, Z, Milan, SJ, Livio, S. Caesarean section versus vaginal delivery for preterm birth in singletons. Cochrane Database Syst Rev 2012; 6: CD000078.Google Scholar
33Hickok, DE, Gordon, DC, Milberg, JA, Williams, MA, Daling, JR. The frequency of breech presentation by gestational age at birth: a large population-based study. Am J Obstet Gynecol 1992 Mar; 166 (3): 851–2.CrossRefGoogle ScholarPubMed
34To, WW. Optimal delivery for preterm breech fetuses: is there any consensus? Hong Kong Med J 2013 Apr 22; 19 (3): 251–7.Google ScholarPubMed
35Lee, KS, Khoshnood, B, Sriram, S, Hsieh, HL, Singh, J, Mittendorf, R. Relationship of cesarean delivery to lower birth weight-specific neonatal mortality in singleton breech infants in the United States. Obstet Gynecol 1998 Nov; 92 (5): 769–74.Google Scholar
36Reddy, UM, Zhang, J, Sun, L, Chen, Z, Raju, TN, Laughon, SK. Neonatal mortality by attempted route of delivery in early preterm birth. Am J Obstet Gynecol 2012 Aug; 207 (2): 117.e1–8.Google Scholar
37Qiu, X, Lee, SK, Tan, K, Piedboeuf, B, Canning, R, Canadian Neonatal, N. Comparison of singleton and multiple-birth outcomes of infants born at or before 32 weeks of gestation. Obstet Gynecol 2008 Feb; 111 (2 Pt 1): 365–71.CrossRefGoogle ScholarPubMed
38Afors, K, Chandraharan, E. Use of continuous electronic fetal monitoring in a preterm fetus: clinical dilemmas and recommendations for practice. J Pregnancy 2011; 2011: 848794.CrossRefGoogle Scholar
39Skupski, DW, Eglinton, GS. Intrapartum fetal stimulation tests: a meta-analysis. Obstet Gynecol 2002 Oct; 100 (4): 830.Google Scholar
40Gawade, PL, Whitcomb, BW, Chasan-Taber, L, Pekow, PS, Ronnenberg, AG, Shah, B, et al.Second stage of labor and intraventricular hemorrhage in early preterm infants in the vertex presentation. J Matern Fetal Neonatal Med 2013 Apr 12; 26 (13): 1292–8.CrossRefGoogle ScholarPubMed
41Boss, RD, Hutton, N, Sulpar, LJ, West, AM, Donohue, PK. Values parents apply to decision-making regarding delivery room resuscitation for high-risk newborns. Pediatrics 2008 Sep; 122 (3): 583–9.CrossRefGoogle ScholarPubMed
42Getahun, D, Oyelese, Y, Salihu, HM, Ananth, CV. Previous cesarean delivery and risks of placenta previa and placental abruption. Obstet Gynecol 2006 Apr; 107 (4): 771–8.Google Scholar
43Fitzpatrick, KE, Sellers, S, Spark, P, Kurinczuk, JJ, Brocklehurst, P, Knight, M. Incidence and risk factors for placenta accreta/increta/percreta in the UK: a national case-control study. PLoS One 2012; 7 (12): e52893.Google Scholar
44Smith, GC, Wood, A. Previous caesarean and the risk of antepartum stillbirth. BJOG 2008 Oct; 115 (11): 1458.Google Scholar
45Landon, MB, Lynch, CD. Optimal timing and mode of delivery after cesarean with previous classical incision or myomectomy: a review of the data. Semin Perinatol 2011 Oct; 35 (5): 257–61.CrossRefGoogle ScholarPubMed
46Wylie, BJ, Gilbert, S, Landon, MB, Spong, CY, Rouse, DJ, Leveno, KJ, et al.Comparison of transverse and vertical skin incision for emergency cesarean delivery. Obstet Gynecol 2010 Jun; 115 (6): 1134–40.Google Scholar
47Dahlke, JD, Mendez-Figueroa, H, Rouse, DJ, Berghella, V, Baxter, JK, Chauhan, SP. Evidence-based surgery for cesarean delivery: an updated systematic review. Am J Obstet Gynecol 2013 Mar 1 (published ahead of print).Google Scholar
48Giacalone, PL, Daures, JP, Vignal, J, Herisson, C, Hedon, B, Laffargue, F. Pfannenstiel versus Maylard incision for cesarean delivery: a randomized controlled trial. Obstet Gynecol 2002 May; 99 (5 Pt 1): 745–50.Google ScholarPubMed
49Bethune, M, Permezel, M. The relationship between gestational age and the incidence of classical caesarean section. Aust N Z J Obstet Gynaecol 1997 May; 37 (2): 153–5.CrossRefGoogle ScholarPubMed
50Greene, RA, Fitzpatrick, C, Turner, MJ. What are the maternal implications of a classical caesarean section? J Obstet Gynaecol 1998 Jul; 18 (4): 345–7.Google ScholarPubMed
51Dodd, JM, Anderson, ER, Gates, S. Surgical techniques for uterine incision and uterine closure at the time of caesarean section. Cochrane Database Syst Rev 2008; (3): CD004732.Google Scholar
52Lao, TT, Halpern, SH, Crosby, ET, Huh, C. Uterine incision and maternal blood loss in preterm caesarean section. Arch Gynecol Obstet 1993; 252 (3): 113–7.CrossRefGoogle ScholarPubMed
53Malvasi, A, Tinelli, A, Guido, M, Cavallotti, C, Dell'Edera, D, Zizza, A, et al.Effect of avoiding bladder flap formation in caesarean section on repeat caesarean delivery. Eur J Obstet Gynecol Reprod Biol 2011 Dec; 159 (2): 300–4.Google Scholar
54Walsh, CA, Walsh, SR. Extraabdominal vs intraabdominal uterine repair at cesarean delivery: a metaanalysis. Am J Obstet Gynecol 2009 Jun; 200 (6): 625.e18.Google Scholar
55Druzin, ML. Atraumatic delivery in cases of malpresentation of the very low birth weight fetus at cesarean section: the splint technique. Am J Obstet Gynecol 1986 Apr; 154 (4): 941–2.Google Scholar
56Pelosi, MA, Apuzzio, J, Fricchione, D, Gowda, VV. The “intra-abdominal version technique” for delivery of transverse lie by low-segment cesarean section. Am J Obstet Gynecol 1979 Dec 15; 135 (8): 1009–11.Google Scholar
57Alexander, JM, Leveno, KJ, Hauth, J, Landon, MB, Thom, E, Spong, CY, et al.Fetal injury associated with cesarean delivery. Obstet Gynecol 2006 Oct; 108 (4): 885–90.Google Scholar
58Jin, Z, Wang, X, Xu, Q, Wang, P, Ai, W. Cesarean section en caul and asphyxia in preterm infants. Acta Obstet Gynecol Scand 2013 Mar; 92 (3): 338–41.CrossRefGoogle ScholarPubMed
59McCall, EM, Alderdice, F, Halliday, HL, Jenkins, JG, Vohra, S. Interventions to prevent hypothermia at birth in preterm and/or low birthweight infants. Cochrane Database Syst Rev 2010; (3): CD004210.Google Scholar
60Rabe, H, Reynolds, G, Diaz-Rossello, J. A systematic review and meta-analysis of a brief delay in clamping the umbilical cord of preterm infants. Neonatology 2008; 93 (2): 138–44.Google Scholar
61Hosono, S, Mugishima, H, Fujita, H, Hosono, A, Minato, M, Okada, T, et al.Umbilical cord milking reduces the need for red cell transfusions and improves neonatal adaptation in infants born at less than 29 weeks’ gestation: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 2008 Jan; 93 (1): F149.Google Scholar
62Raju, TN. Timing of umbilical cord clamping after birth for optimizing placental transfusion. Curr Opin Pediatr 2013 Apr; 25 (2): 180–7.Google Scholar
63RCOG. Scientific Impact Paper No 14: May: 2009. Clamping of the Umbilical Cord and Placental Transfusion.Google Scholar
64Leavitt, BG, Huff, DL, Bell, LA, Thurnau, GR. Placental drainage of fetal blood at cesarean delivery and feto maternal transfusion: a randomized controlled trial. Obstet Gynecol 2007 Sep; 110 (3): 608–11.CrossRefGoogle ScholarPubMed
65Halperin, ME, Moore, DC, Hannah, WJ. Classical versus low-segment transverse incision for preterm caesarean section: maternal complications and outcome of subsequent pregnancies. Br J Obstet Gynaecol 1988 Oct; 95 (10): 990–6.CrossRefGoogle ScholarPubMed
66Shipp, TD, Zelop, CM, Repke, JT, Cohen, A, Caughey, AB, Lieberman, E. Intrapartum uterine rupture and dehiscence in patients with prior lower uterine segment vertical and transverse incisions. Obstet Gynecol 1999 Nov; 94 (5 Pt 1): 735–40.Google ScholarPubMed
67Martin, JN Jr., Perry, KG Jr., Roberts, WE, Meydrech, EF. The case for trial of labor in the patient with a prior low-segment vertical cesarean incision. Am J Obstet Gynecol 1997 Jul; 177 (1): 144–8.Google Scholar