Table 4.

Perinatal management at the threshold of viability

• Antenatal counselling should be provided by senior neonatologists, obstetricians, and midwives

• Management decisions should depend on what the parents and their medical advisers think is in the child's best interests

• Parents should have accurate information on likely outcomes for their infant—including their chances of survival and the risk of longer term disability

• Information on outcomes provided to parents should cite data from large cohort studies that reported the outcome of all pregnancies for each week of gestation (not just for infants admitted to intensive care units)

• Perinatal management plans should consider the mode of delivery, use of intrapartum monitoring, and immediate care of the newborn

• Decisions not to provide active resuscitation or intensive care should not be binding, particularly if the newborn seems more mature than anticipated

• It may be appropriate to provide full resuscitation and intensive care to infants at birth until the clinical progress becomes clearer and further discussions with the family have been possible

• Parents should be supported throughout and encouraged to seek advice and further support from others, such as family members and religious advisers

• Infants who are not actively resuscitated or in whom active resuscitation is withdrawn should receive palliative care