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NeoReviews Vol.4 No.6 2003 e153
© 2003 American Academy of Pediatrics

Article

Prenatal Consultation at the Limits of Viability

^* Associate Professor, Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA

The first 300 words of the full text of this article appear below.

	Objectives

 
After completing this article, readers should be able to:

1. List the professionals who should be involved in counseling the pregnant woman threatening to deliver at 22 to 24 weeks’ gestation.
   
2. List the key issues to be discussed at the initial counseling visit.
   

	Introduction

 
What is meant by "limits of viability"? Use of the plural, not singular, form of the word "limit" implies some variability in the definition. Nevertheless, most neonatologists would agree that survival of infants younger than approximately 22 to 23 weeks’ estimated gestational age is universally dismal and that resuscitative efforts should not be undertaken when a neonate is born at this point in pregnancy. A woman threatening to deliver at 22 to 24 weeks’ gestational age and her partner face many medical, emotional, and ethical questions, with even more difficult postnatal decisions. What medical professionals should be involved in counseling these women, the nature of the information provided during the consultation, and the training of professionals to handle these challenging situations are the topics of this article.

	Who Should Be Involved in Counseling Pregnant Women?

 
Obviously a woman’s obstetrician or maternal-fetal medicine specialist plays an integral role in caring for, educating, and supporting her when she is in preterm labor. Certainly this professional is the optimal source of information regarding decisions on obstetric issues such as tocolytics (indications for, risks and benefits of) and route of delivery. Others who may participate in such counseling include general pediatricians, pediatric subspecialists, genetic counselors, social workers, and chaplains. However, there is no better medical professional to describe the many aspects of what it means to be born preterm than the neonatologist. The neonatologist not only can describe the immediate threats to life, but also the long-term sequelae of preterm delivery. Unlike pediatric subspecialists, who focus on particular organs or organ systems, the neonatologist is a generalist who has expertise . . . [Full Text of this Article]

This article has been cited by other articles:

				A. G.S. Philip and R. Usher Historical Perspectives: Neonatology: The Long View NeoReviews, January 1, 2005; 6(1): e3 - e11. [Full Text] [PDF]

				R. J. Boyle Ethical Issues in the Care of the Neonate: Overview NeoReviews, November 1, 2004; 5(11): e471 - e476. [Full Text] [PDF]