Non-viable delivery at 20-23 weeks gestation: observations and signs of life after birth

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Abstract
Objective: To describe the outcome of labour, signs of life at birth, and duration of survival after delivery at 20–23 weeks gestation. Design: An observational study using data from the Confidential Enquiry into Stillbirths and Deaths in Infancy 1995–2000. Setting: All deliveries to mothers resident in Trent Health Region. Patients: 1306 babies delivered at 20–23 weeks gestation. Results: Termination of pregnancy accounted for 33% of deliveries at 20–23 weeks; these were excluded from further analysis. Spontaneous delivery occurred at a frequency of 2.5/1000 deliveries; 30% died before the onset of labour, 27% died during labour, and 35% showed signs of life at birth. Of the latter, 8% were not registered as statutory live births. Of the live born infants, the largest group (39%) had a heart beat but no other signs of life. There was no trend for infants of lower gestation to show fewer signs of life. Duration of survival varied widely (median 60 minutes at 20–22 weeks), and this did not increase with gestation until 23 weeks (median six hours), probably because of selective treatment. Survival curves are presented for each gestation group. At 23 weeks, 4.5% survived to 1 year of age; all were > 500 g birth weight. Below 23 weeks gestation, none survived, and 94% had died within 4 hours of age. Conclusions: This information on surviving labour, signs of life at birth, duration of survival, and birth weight at 20–23 weeks gestation should help decision making in the management of pre-viable delivery.