Periviable Birth Executive Summary of a Joint Workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Academy of Pediatrics, and American College of Obstetricians and Gynecologists
Periviable Birth Executive Summary of a Joint Workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Academy of Pediatrics, and American College of Obstetricians and Gynecologists
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DOI：
10.1097/aog.0000000000000243
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发表时间：
2014-05-01
影响因子：
7.2
通讯作者：
Joseph, Gerald F., Jr.
中科院分区：
文献类型：
--
作者：
Raju, Tonse N. K.;Mercer, Brian M.;Joseph, Gerald F., Jr.
这是关于预期在妊娠期（广义上定义为妊娠 20 0/7 至 25 6/7 周）分娩的妇女的管理和咨询问题以及新生儿的治疗选择的研讨会的执行摘要。在审查现有文献后，研讨会小组指出，幸存者的新生儿存活率和神经发育障碍率在整个妊娠期差异很大，并且受到产科和新生儿管理实践（例如产前类固醇、宫缩抑制剂和抗生素管理；剖腹产；以及当地围产期护理、新生儿复苏和重症监护支持方案）的显着影响。反过来，这些又受到当地和区域生存能力限制定义差异的影响。由于做出困难的管理决策的复杂性，产科和新生儿团队应在可行的情况下在与家人会面之前进行协商。家庭咨询应以建立相互信任、尊重和理解为目标，并应采用基于证据的咨询方法。由于临床情况会随着胎龄的增加而迅速变化，因此咨询应包括在咨询时讨论各种孕产妇和新生儿干预措施的益处和风险。随着临床情况的发展，应该制定后续咨询计划。该小组提出了一项研究议程，并建议制定有关面临围产期婴儿出生的家庭的护理和咨询的教育课程。
This is an executive summary of a workshop on the management and counseling issues of women anticipated to deliver at a periviable gestation (broadly defined as 20 0/7 through 25 6/7 weeks of gestation), and the treatment options for the newborn. Upon review of the available literature, the workshop panel noted that the rates of neonatal survival and neurodevelopmental disabilities among the survivors vary greatly across the periviable gestations and are significantly influenced by the obstetric and neonatal management practices (eg, antenatal steroid, tocolytic agents, and antibiotic administration; cesarean birth; and local protocols for perinatal care, neonatal resuscitation, and intensive care support). These are, in turn, influenced by the variations in local and regional definitions of limits of viability. Because of the complexities in making difficult management decisions, obstetric and neonatal teams should confer prior to meeting with the family, when feasible. Family counseling should be coordinated with the goal of creating mutual trust, respect, and understanding and should incorporate evidence-based counseling methods. Since clinical circumstances can change rapidly with increasing gestational age, counseling should include discussion of the benefits and risks of various maternal and neonatal interventions at the time of counseling. There should be a plan for follow-up counseling as clinical circumstances evolve. The panel proposed a research agenda and recommended developing educational curricula on the care and counseling of families facing the birth of a periviable infant.