LAUSR

BACKGROUND Management of delivery at periviable gestation requires complex counseling and decision making, including difficult choices about monitoring and potential cesarean delivery (CD) for fetal benefit. Our objective was to characterize decisions that patients make regarding fetal monitoring and potential CD for fetal benefit when delivering in the periviable period, and associations with perinatal and obstetric outcomes. We hypothesize that a significant number of patients forgo monitoring and intervention potential CD for fetal benefit in the periviable period when offered the opportunity to do so. STUDY DESIGN Retrospective cohort study of non-anomalous singleton pregnancies delivering between 23w0d and 25w6d at a tertiary care center from 2015 to 2020. Since 2015, these patients are offered the ability to accept or decline fetal monitoring, potential CD for fetal benefit, and active resuscitation of a liveborn neonate. The frequency of patients desiring p for fetal benefit identified, and associations with CD and intrapartum demise were analyzed. RESULTS Fifty subjects were included. Seventy-eight percent (n=39) desired monitoring and potential CD for fetal benefit, and 84% (n=42) desired resuscitation if the neonate was born alive. This varied by gestational age. Sixty-nine percent of pregnancies in which potential CD for fetal benefit was desired resulted in CD (27/39), of which 85% were classical (23/27). Intrapartum fetal demise occurred in 45% (5/11) of pregnancies in which monitoring was not performed. CONCLUSION While a majority of patients delivering between 23w0d and 25w6d desired monitoring and potential CD for fetal benefit, this varied significantly by gestational age. The decision to perform monitoring and potential CD for fetal benefit was associated with a high frequency of CD, while the decision to forgo monitoring was associated with high frequency of intrapartum demise.