Childbirth at the limit of viability: experience of the Kyiv Perinatal Center

Abstract

The article discusses the main medical consequences of extreme prematurity, the contradictions of the medical and ethical point of view of raising such children. There are differences in the term of viability in different countries and different institutions of obstetric care. The measures of resuscitation care provided to extremely premature newborns, as well as the potential consequences of the survival of those born in extreme terms - motor and cognitive disorders, impaired vision and hearing, and socialization - are considered.

Purpose - to determine the viable period in the conditions of the Kyiv Perinatal Center based on the results of 2014-2022 and to formulate the principles of providing assistance to women in labor and newborns of this category.

Materials and methods. The indicators of neonatal mortality in the Perinatal Center of Kyiv for the years 2014-2022 at birth at 22-26 weeks, as well as the prevalence of severe health disorders during further observation, were analyzed. A comparison of these indicators with global data was made.

Results. Analysis of neonatal mortality rates showed that at the beginning of the work of the Perinatal Center, the term of viability was above the limit of 26 weeks, in 2013 it shifted to the limit of 26 weeks, and in 2014 to 25 weeks, remaining there even now. This term is shorter than in Ukraine as a whole, i.e. transferring a pregnant woman with unavoidable very early premature birth to a tertiary center optimizes the results for the child. Monitoring of the further development of such newborns showed that at 22-23 weeks 10 out of 10 newborns, at 24 weeks - 8 out of 10, at 25 weeks - 6 out of 10, and at 26 weeks - 5 out of 10 have serious health disorders.  A detailed description of the activities of the Perinatal management clinical group is provided extremely premature births, which provides high-risk patients with delivery before 27 weeks of counseling in decision-making regarding neonatal resuscitation, as well as rehabilitation after reproductive losses. 

Conclusions. The gestational period of viability in the Perinatal Center is 25 weeks. According to the Perinatal Center, the frequency of severe health disorders in extremely premature babies ranges from 100% at 22 weeks to 50% at 26 weeks. Implementation of the policy of Perinatal management of extremely premature births allows to observe the ethical principles of autonomy and justice when providing care to a newborns. The Perinatal Center of Kyiv operates a full cycle of providing assistance to women with very early premature births - from observing ethical principles in providing assistance to newborns to psychological rehabilitation after reproductive loss and planning the next pregnancy.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution.

No conflict of interests was declared by the authors.