CMAJ. 1994 Sep 1;151(5):547-53.
To offer guidelines for parents, physicians and other members of the health-care team for management of the probable birth of an infant with a gestational age of 26 completed weeks or less.
Vaginal birth or birth by cesarean section for fetal indications and active treatment or palliative care of the infant at birth.
Increased risk of complications for the mother from cesarean section at this stage of pregnancy and the difficulty in making a prognosis before or at birth for an infant of this gestational age.
Published survival rates and risks of impairment or disability for infants of each gestational age; current information provided by directors of follow-up clinics in Canadian university-based pediatric programs.
The recommended management of the woman and her fetus or infant is based on many underlying considerations, including the best interests of the mother and her infant and the views of fully informed parents.
BENEFITS, HARMS AND COSTS: Use of these guidelines will enable health care providers to offer parents of infants of extremely low gestational age therapeutic choices before birth based on full information on likely outcomes, to avoid unnecessary cesarean section and to minimize suffering when treatment of infants is not in their best interests.
According to current Canadian outcome data, fetuses with a gestational age of less than 22 completed weeks are not viable and those with an age of 22 weeks rarely viable. Their mothers are not, therefore, candidates for cesarean section, and the newborns should be provided with compassionate care, rather than active treatment. The outcomes for infants with a gestational age of 23 to 24 completed weeks vary greatly. Careful consideration should be given to the limited benefits for the infant and potential harms of cesarean section, as well as to the expected results of resuscitation at birth. Cesarean section, when indicated, and any required neonatal treatment are recommended for infants with gestational ages of 25 and 26 completed weeks; most infants of this age will survive, and most survivors will not be severely disabled. Treatment of all infants with a gestational age of 22 to 26 weeks should be tailored to the infant and family and should involve fully informed parents.
Members of the Fetus and Newborn Committee of the Canadian Paediatric Society (CPS) were involved in the preparation of this article, which was reviewed and modified by the Ethics Committee of the CPS and the Maternal-Fetal Medicine Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC). A draft was circulated to Canadian university-based perinatal programs and members of the Section on Neonatal-Perinatal Medicine of the CPS. Comments from physicians and bioethicists were incorporated, when possible, into the final version. There are no similar guidelines in North America.
为父母、医生及其他医疗团队成员提供指导方针，以管理孕周满26周及以下婴儿的可能出生情况。
经阴道分娩或因胎儿指征行剖宫产，以及出生时对婴儿进行积极治疗或姑息治疗。
在此孕周阶段剖宫产会增加母亲并发症的风险，且在此孕周的婴儿出生前或出生时难以做出预后判断。
已发表的各孕周婴儿的存活率及受损或致残风险；加拿大大学附属儿科项目随访诊所主任提供的当前信息。
对该女性及其胎儿或婴儿的推荐管理基于诸多潜在考量，包括母亲和婴儿的最佳利益以及充分知情的父母的意见。
益处、危害及成本：使用这些指导方针将使医疗服务提供者能够在出生前根据关于可能结果的全面信息，为孕周极低的婴儿的父母提供治疗选择，避免不必要的剖宫产，并在对婴儿的治疗不符合其最佳利益时将痛苦降至最低。
根据加拿大当前的结果数据，孕周未满22周的胎儿无法存活，22周的胎儿极少能存活。因此，其母亲不适合剖宫产，应为新生儿提供同情护理而非积极治疗。孕周满23至24周的婴儿的结局差异很大。应仔细考虑剖宫产对婴儿的有限益处和潜在危害，以及出生时复苏的预期结果。对于孕周满25和26周的婴儿，建议在有指征时行剖宫产及进行任何必要的新生儿治疗；这个孕周的大多数婴儿会存活，且大多数幸存者不会严重致残。对所有孕周在22至26周的婴儿的治疗应根据婴儿和家庭情况量身定制，并应让父母充分知情。
加拿大儿科学会（CPS）胎儿与新生儿委员会成员参与了本文的编写，本文由CPS伦理委员会及加拿大妇产科医师协会（SOGC）母胎医学委员会进行了审查和修改。一份草案分发给了加拿大大学附属围产期项目及CPS新生儿 - 围产期医学分会成员。医生和生物伦理学家的意见在可能的情况下被纳入了最终版本。北美没有类似的指导方针。
