The impact of fetal compromise on outcome at the border of viability

• Published in: American journal of obstetrics and gynecology 1998-05, Vol.178 (5), p.909-915
• Main Authors: Batton, Daniel G., DeWitte, David B., Espinosa, Roberto, Swails, Tammy L.
• Format: Article
• Language: English
• Subjects: Acidosis - complications; Anemia - complications; Anemia - congenital; Biological and medical sciences; Borderline viable babies; Congenital Abnormalities; Diseases of mother, fetus and pregnancy; ethical decisions; Female; fetal compromise; Fetal Diseases; Fetal Growth Retardation - complications; Gynecology. Andrology. Obstetrics; Humans; Infant Mortality; Infant, Newborn; Infant, Premature; Medical sciences; Nervous System Diseases - complications; outcome; Pregnancy; Pregnancy. Fetus. Placenta; prematurity; Sepsis - complications; Sepsis - congenital; Survival Rate
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/S0002-9378(98)70522-8

OBJECTIVE: Our goal was to evaluate the impact of fetal compromise on the outcome of borderline viable babies. STUDY DESIGN: All 142 babies born in our hospital from 1990 to 1995 with a gestational age of 23 to 25 weeks were included. Fetal compromise was considered present if one of the following was documented: a major anomaly, congenital sepsis, chronic intrauterine infection, intrauterine drug exposure, congenital anemia, severe growth restriction, fetal acidosis, or cardiorespiratory and neurologic depression in the delivery room. RESULTS: The 43 babies who had at least one cause of fetal compromise had a lower birth weight ( p < 0.001), but there were no other differences in demographics or complications of prematurity. The survival rate was significantly better for babies free of fetal compromise (75% vs 33%, p < 0.001), particularly for babies born at 23 weeks of gestation (75% vs 6%, p < 0.001). For surviving babies free of fetal compromise, the outcome at 23 weeks was comparable to that at 24 to 25 weeks for major causes of long-term neurologic morbidity. CONCLUSIONS: Like advancing gestational age and increasing birth weight, the absence of fetal compromise has a major beneficial impact on the outcome of borderline viable babies that might be important when decisions are made about the appropriate level of support. (Am J Obstet Gynecol 1998;178:909-15.)