The edge of viability

Abstract

Prematurity contributes to the majority of perinaral morbidity and mortality. Over the last decade, because of advances in perinatal care there has been both improvements in neonatal outcome and decrease in perinatal morbidity. Unit survival and regional survival rate should be available to parents at the time of counselling. When both gestational age and weight are clearly established, the prognosis may be clarified, as survival at each gestarlonal age varies with birth weight. There is no adverse consequence of a single course of steroids and these babies should be born in places where the experts are available. Caesarean delivery is of no benefit for extreme premature babies and may result in large number of survivors at the expense of handicap. Care of the babies at extremes of viability is extremely difficult medically ethically and financially. Each decision should be carefully considered by the parents, obstetricians and paediatricians prior to embarking on any heroic measures.