Periviable antenatal care, labor and delivery, and initial resuscitation: Some chores to get done before you start.

Abstract

Resuscitation practices of infants born in the periviable period are evolving rapidly. This review seeks to describe the latest information on antenatal management, including obstetric considerations; delivery room management, including issues of cord management, respiratory support, and thermoregulation; and neonatal considerations, such as preparation for admission to the neonatal ICU, for infants born in the periviable period. As we describe controversies and considerations in management, we will share the management path our center has chosen for each key decision point. Our review will also highlight important gaps in the literature and describe directions for future research. IMPACT: Pregnant women at risk for birth at periviable gestational age present unique challenges to counseling and care Optimization of prenatal care and delivery room resuscitation of these extremely preterm neonates require coordination of care among obstetric and neonatal staff This article provides an up-to-date, comprehensive review of the evidence behind key preparation and management decisions that must be made surrounding the birth and delivery room resuscitation of periviable infants.