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Fetal viability

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Fetal viability is the ability of a fetus to survive outside the uterus.[1]

Definitions

The potential of the fetus to survive outside the uterus after birth, natural or induced. Fetal viability depends largely on the fetal organ maturity, and environmental conditions.[2]

According to Websters Encyclopedic Unabridged Dictionary of the English Language, viable of a fetus it means having reached such a stage of development as to be capable of living, under normal conditions, outside the uterus. Viability exists as a function of biomedical and technological capacities, which are different in different parts of the world. As a consequence, there is, at the present time, no worldwide, uniform gestational age that defines viability.[3]

Scientific thresholds

There is no sharp limit of development, age, or weight at which a fetus automatically becomes viable.[1] According to studies between 2003 and 2005, 20 to 35 percent of babies born at 23 weeks of gestation survive, while 50 to 70 percent of babies born at 24 to 25 weeks, and more than 90 percent born at 26 to 27 weeks, survive.[4] It is rare for a baby weighing less than 500g (17.6 ounces) to survive.[1] A baby's chances for survival increases 3-4% per day between 23 and 24 weeks of gestation and about 2-3% per day between 24 and 26 weeks of gestation. After 26 weeks the rate of survival increases at a much slower rate because survival is high already.[5]

 
Stages in prenatal development, showing viability and point of 50% chance of survival (limit of viability) at bottom. Weeks and months numbered by gestation.
Completed weeks of Gestation at birth 21 and less 22 23 24 25 26 27 30 34
Chance of survival[6] 0% 0-10% 10-35% 40-70% 50-80% 80-90% >90% >95% >98%

Echocardiography, Color Doppler Energy, 3D sonography, prenatal diagnosis (cordocentesis, analysis of fetal cells in maternal blood,.), fetal pulse oximetry, mathematical analysis of the signal are the methods which should be used at the highest level of perinatal care. Today, the prospect of survival is only about 1 in 10 at 23 weeks, and if the child lives it is more likely to be handicapped that not. At 24 weeks the chance of a normal survivor is about 50%, and after this the odds are in favor of a normal survivor. Considering this data, intensive care should be an optional choice for fetuses at 23 and 24 weeks of gestation and should be offered to every fetus at 25 weeks or more.[7]

Template:Globalize/US

United States

The United States Supreme Court stated in Roe v. Wade (1973) that viability (i.e., the "interim point at which the fetus becomes ... potentially able to live outside the mother's womb, albeit with artificial aid"[8]) "is usually placed at about seven months (28 weeks) but may occur earlier, even at 24 weeks."[8] The 28-week definition became part of the "trimester framework" marking the point at which the "compelling state interest" (under the doctrine of strict scrutiny) in preserving potential life became possibly controlling, permitting states to freely regulate and even ban abortion after the 28th week.[8] The subsequent Planned Parenthood v. Casey (1992) modified the "trimester framework," permitting the states to regulate abortion in ways not posing an "undue burden" on the right of the mother to an abortion at any point before and after viability; on account of technological developments between 1973 and 1992, viability itself was legally dissociated from the hard line of 28 weeks, leaving the point at which "undue burdens" were permissible variable depending on the technology of the time and the judgment of the state legislatures.

Forty-one states now have laws restricting post-viability abortions. Some allow doctors to decide for themselves if the fetus is viable. Some require doctors to perform tests to prove a fetus is pre-viable and require multiple doctors to certify the findings. Eleven states have banned the procedure called intact dilation and extraction (IDE)--also known as partial-birth abortion--in the belief that this procedure is used mainly post-viability.[9]

Limit of viability

The limit of viability is the gestational age at which a prematurely born fetus/infant has a 50% chance of long-term survival outside its mother's womb. With the support of neonatal intensive care units, the limit of viability in the developed world has declined since 50 years ago, but has remained unchanged in the last 12 years.[10][11] Currently the limit of viability is considered to be around 24 weeks although the incidence of major disabilities remains high at this point.[12][13] Neonatologists generally would not provide intensive care at 23 weeks, but would from 26 weeks.[14][15]

During the past several decades, neonatal care has improved with advances in medical science, and therefore the limit of viability has moved earlier.[16] As of 2006, the two youngest children to survive premature birth are thought to be James Elgin Gill (born on 20 May 1987 in Ottawa, Canada, at 21 weeks and 5 days gestational age),[17][18] and Amillia Taylor (born on 24 October 2006 in Miami, Florida, at 21 weeks and 6 days gestational age).[19][20] Both children were born just under 22 weeks from fertilization, or a few days past the midpoint of an average full-term pregnancy.

Amillia Taylor is also often cited as the most-premature baby.[19] She was born on 24 October 2006 in Miami, Florida, at 21 weeks and 6 days gestation.[21]At birth, she was 9 inches (22.86 cm) long and weighed 10 ounces (283 grams).[19] She suffered digestive and respiratory problems, together with a brain hemorrhage. She was discharged from the Baptist Children's Hospital on 20 February 2007.[19]

The lower limit of viability is approximately five months gestational age, and usually later.[22]

Factors that Influence the chance of survival

-The baby's gestational age (number of completed weeks of pregnancy) at the time of birth

-The baby's weight

-The presence or absence of breathing problems

-The presence or absence of congenital abnormalities or malformations

-The presence or absence of other severe diseases, especially infection


Other factors may influence survival by altering the rate of organ maturation or by changing the supply of oxygen to the developing fetus.

-Rupture of the fetal membranes before 24 weeks of gestation with loss of amniotic fluid markedly decreases the baby's chances of survival even if the baby is delivered much later.

-Male infants are slightly less mature and have a slightly higher risk of dying than female infants.

-For a given weight, African-American babies have a slightly better survival than Caucasian; most other races are intermediate between the two.

-Diabetes in the mother, if not well controlled, slows organ maturation and these infants have a higher mortality.

-Severe high blood pressure before the 8th month of pregnancy may cause changes in the placenta, decreasing the delivery of nutrients and/or oxygen to the developing fetus and leading to problems before and after delivery. [23]

See also

References

1. Breborowicz GH (2001). Limits of fetal viability and its enhancement.. [ONLINE] Available at: http://www.ncbi.nlm.nih.gov/pubmed/11753511. [Last Accessed 19 November 2012 ].

2. (2012). Fetal Viability. [ONLINE] Available at: http://www.reference.md/files/D005/mD005328.html. [Last Accessed 15 November 2012].

3. Franklin Foer (1997). Fetal Viability. [ONLINE] Available at: http://www.slate.com/articles/news_and_politics/the_gist/1997/05/fetal_viability.html. [Last Accessed 14 November 2012].

4. United States. National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (2006-05-23). FETAL VIABILITY AND DEATH. [ONLINE] Available at: https://scholarworks.iupui.edu/bitstream/handle/1805/583/OS76-127_VII.pdf?sequence=1. [Last Accessed 17 November 2012].

5.(). What are the chances that my baby will survive?. [ONLINE] Available at: http://www.spensershope.org/chances_for_survival.htm. [Last Accessed 14 November 2012].

Footnotes

  1. ^ a b c Moore, Keith and Persaud, T. The Developing Human: Clinically Oriented Embryology, p. 103 (Saunders 2003).
  2. ^ (2012). Fetal Viability. [ONLINE] Available at: http://www.reference.md/files/D005/mD005328.html. [Last Accessed 15 November 2012].
  3. ^ Breborowicz GH
  4. ^ March of Dimes --> Neonatal Death Retrieved on September 2, 2009. In turn citing:
    • Tyson JE, Parikh NA, Langer J, Green C, Higgins RD (2008). "Intensive care for extreme prematurity--moving beyond gestational age". N. Engl. J. Med. 358 (16): 1672–81. doi:10.1056/NEJMoa073059. PMC 2597069. PMID 18420500. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
    • Luke B, Brown MB (2006). "The changing risk of infant mortality by gestation, plurality, and race: 1989-1991 versus 1999-2001". Pediatrics. 118 (6): 2488–97. doi:10.1542/peds.2006-1824. PMID 17142535. {{cite journal}}: Unknown parameter |month= ignored (help)
    • The American College of Obstetricians and Gynecologists (2002). "ACOG Practice Bulletin: Clinical Management Guidelines for Obstetrcian-Gynecologists: Number 38, September 2002. Perinatal care at the threshold of viability". Obstet Gynecol. 100 (3): 617–24. PMID 12220792. {{cite journal}}: Unknown parameter |month= ignored (help)
  5. ^ (). What are the chances that my baby will survive?. [ONLINE] Available at: http://www.spensershope.org/chances_for_survival.htm. [Last Accessed 14 November 2012].
  6. ^ (). What are the chances that my baby will survive?. [ONLINE] Available at: http://www.spensershope.org/chances_for_survival.htm. [Last Accessed 14 November 2012].
  7. ^ Breborowicz GH
  8. ^ a b c Roe v. Wade, 410 U.S. 113, 160, 93 S.Ct. 705, 730 (1973).
  9. ^ Franklin Foer?
  10. ^ Fergus Walsh (11 April 2008). "Prem baby survival rates revealed". BBC News. Retrieved 2008-05-11.
  11. ^ "Early baby survival 'unchanged'". BBC News. 9 May 2008. Retrieved 2008-05-11.
  12. ^ Kaempf JW, Tomlinson M, Arduza C; et al. (2006). "Medical staff guidelines for periviability pregnancy counseling and medical treatment of extremely premature infants". Pediatrics. 117 (1): 22–9. doi:10.1542/peds.2004-2547. PMID 16396856. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link) - in particular see TABLE 1 Survival and Neurologic Disability Rates Among Extremely Premature Infants
  13. ^ Morgan MA, Goldenberg RL, Schulkin J (2008). "Obstetrician-gynecologists' practices regarding preterm birth at the limit of viability". J. Matern. Fetal. Neonatal. Med. 21 (2): 115–21. doi:10.1080/14767050701866971. PMID 18240080.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  14. ^ Vavasseur C, Foran A, Murphy JF (2007). "Consensus statements on the borderlands of neonatal viability: from uncertainty to grey areas". Ir Med J. 100 (8): 561–4. PMID 17955714. All would provide intensive care at 26 weeks and most would not at 23 weeks. The grey area is 24 and 25 weeks gestation. This group of infants constitute 2 per 1000 births.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  15. ^ Kaempf et al. (2006) Table of neonatologists rescussitation advice showing gestation ages at which they have neutral poistions whether they would or would not recommend rescussitation.
  16. ^ Roe v. Wade, 410 U.S. 113 (1973) ("viability is usually placed at about seven months (28 weeks) but may occur earlier, even at 24 weeks.") Retrieved 2007-03-04.
  17. ^ "Powell's Books - Guinness World Records 2004 (Guinness Book of Records) by". Retrieved 2007-11-28.
  18. ^ "Miracle child". Retrieved 2007-11-28.
  19. ^ a b c d "Most-premature baby allowed home". BBC News. 2007-02-21. Retrieved 2007-05-05. Cite error: The named reference "bbcAmillia" was defined multiple times with different content (see the help page).
  20. ^ Baptist Hospital of Miami, Fact Sheet (2006).
  21. ^ "trithuc.thanhnienkhcn.org.vn". Retrieved 2007-11-28.
  22. ^ Halamek, Louis. "Prenatal Consultation at the Limits of Viability", NeoReviews, Vol.4 No.6 (2003): "most neonatologists would agree that survival of infants younger than approximately 22 to 23 weeks’ estimated gestational age [i.e. 20 to 21 weeks' estimated fertilization age] is universally dismal and that resuscitative efforts should not be undertaken when a neonate is born at this point in pregnancy."
  23. ^ (). What are the chances that my baby will survive?. [ONLINE] Available at: http://www.spensershope.org/chances_for_survival.htm. [Last Accessed 14 November 2012].
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