Cypher Maternal-Fetal Solutions, LLC, Gig Harbor, Washington (Ms Cypher); and Womack Army Medical Center, Fort Bragg, North Carolina (Dr Foglia).
J Perinat Neonatal Nurs. 2020 Apr/Jun;34(2):146-154. doi: 10.1097/JPN.0000000000000473.
One of the most complex clinical problems in obstetrics and neonatology is caring for pregnant women at the threshold of viability. Births near viability boundaries are grave events that carry a high prevalence of neonatal death or an increased potential for severe lifelong complications and disabilities among those who survive. Compared with several decades ago, premature infants receiving neonatal care by today's standards have better outcomes than those born in other eras. However, preterm labor at periviability represents a more complex counseling and management challenge. Although preterm birth incidence between 20/7 and 25/7 weeks has remained unchanged, survival rates at earlier gestational ages have increased as perinatal and neonatal specialties have become more adept at caring for this at-risk population. Women face difficult choices about obstetric and neonatal interventions in light of uncertainties around survival and outcomes. This article reviews current neonatal statistics in reference to short- and long-term outcomes, key concepts in obstetric clinical management of an anticipated periviable birth, and counseling guidance to ensure shared-decision making.
在产科和新生儿学中，最复杂的临床问题之一是照顾接近可存活期的孕妇。接近可存活期边界的分娩是严重的事件，新生儿死亡率高，幸存者有严重终身并发症和残疾的潜在风险增加。与几十年前相比，按照今天的标准接受新生儿护理的早产儿的结局要好于其他时代出生的早产儿。然而，接近可存活期的早产分娩代表了更复杂的咨询和管理挑战。尽管 20/7 至 25/7 周之间的早产发生率保持不变，但随着围产儿和新生儿专科更擅长照顾这一高危人群，更早的孕龄生存率有所提高。鉴于生存和结局的不确定性，女性在产科和新生儿干预方面面临着艰难的选择。本文回顾了目前的新生儿统计数据，包括短期和长期结局、预期接近可存活期分娩的产科临床管理中的关键概念，以及确保共同决策的咨询指导。
