Pregnancy and Neonatal Management for 22-23 Weeks Gestational Age Deliveries

Objective To assess delivery management and survival of infants born at 220/7–236/7 weeks gestational age (GA) before and after periviability guideline implementation. Study Design Retrospective cohort study of live births at 220/7–236/7 weeks GA (2010-2022). Maternal interventions, parental preferences, and neonatal outcomes were compared between two Epochs: pre-guideline (2010–2014) and post-guideline (2015–2022) using t-tests, chi-square, and regression analyses. Result Among 216 infants (90 Epoch 1; 126 Epoch 2), Epoch 2 showed significantly higher rates of antenatal steroid use (14.4% vs. 49.2%), magnesium sulfate use (15.6% vs. 46.4%), fetal monitoring (11.1% vs. 42.7%), and Cesarean delivery (2.2% vs. 18.3%) (all p < 0.0001). Parental requests for full resuscitation increased (7.8% vs 28.6%, p = 0.004). Survival to hospital discharge improved at both 22- and 23-weeks GA. Conclusion Periviability guideline implementation was associated with increased interventions, greater parental resuscitation requests, and improved survival among periviable infants.