Article Text

ANTENATAL MANAGEMENT OF EXTREME PRETERM NEWBORNS: TO INTERVENE OR NOT
  1. R A Khan1,
  2. M P O Connell2,
  3. E M Dempsey3
  1. 1Department of Neonatology, Coombe Women and Infant University Hospital, Dublin, Ireland
  2. 2Department of Obstetrics and Gynaecology, Coombe Women and Infant University Hospital, Dublin, Ireland
  3. 3Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland

Abstract

Background Attitudes towards antenatal management of the expectant mother at the limits of viability differ widely across health care providers.

Aim To explore the opinions of healthcare providers towards antenatal management of expectant mother and extreme preterm newborn in Ireland.

Methods An anonymous questionnaire was sent to various working health care providers in Ireland. Questions were related to antenatal and intra partum management of the expectant mother from 22 to 28 weeks gestation.

Results Response rate was 55%. 21% of respondents would advocate administering antenatal corticosteroids at 22 weeks, at 23 weeks 42% of neonatologists advocate antenatal steroids and 100% at 24 weeks. The majority of respondents felt that a neonatologist should counsel an expectant mother at 24 weeks whilst the majority felt that an obstetrician should counsel solely at 22 weeks. 92% neonatologists would wish for an obstetrician to council parents at 22 weeks. 50% of all health care providers advocate cardiotocographic monitoring at 24 weeks gestation and above. Both obstetrician and neonatologist do not advocate CTG monitoring at 22 weeks gestation. Only 8% provide written information on survival and longterm outcome. Neonatologists were more likely than obstetrician to advocate caesarean section at 25 weeks for breech. Obstetricians were more willing to perform cesarean section at 25 weeks for fetal distress.

Conclusions Different professional groups have different views on antenatal management of microprems.24 weeks would appear to be the limit at which most would advocate some form of intervention. Establishment and provision of national outcome data may help decision making at the limits of viability

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