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Survival and long-term outcome of infants delivered at 24 to 28 weeks' gestation, by method of delivery and fetal presentation.

Significant advances in perinatal intensive care and the increased chances of neonatal survival that have evolved in the last decade have posed moral and medicolegal questions for obstetricians that are as yet unanswered. Aggressive delivery management and major interventions for infants who were not long ago considered to be nonviable have become increasingly common. On the other hand, reports of high incidence of handicaps in the survivors cause great concern and add to the dilemma facing obstetricians. In this study, survival and long-term morbidity in 169 infants delivered at 24 to 28 weeks' gestation have been analyzed according to method of delivery and fetal presentation. At 24 to 25 weeks, survival was extremely low (10.5%) while major handicap rate was very high (42.9%). Infants born at 26 to 28 weeks' gestation had a considerably higher survival potential (42% to 74%), with an incidence of major handicap of less than 10%. At 26 to 28 weeks, abdominal delivery did not alter survival prospects of vertex-presenting infants; however, it improved survival of breech-presenting infants (70.0% compared with 22.2%) and showed a trend toward a lower handicap rate in the survivors.