The new age of periviability.

Purpose of review: This review focuses on the clinical and ethical complexities of managing pregnancies between 20 and 25 weeks and 6 days of gestation, known as periviability, where fetal survival is uncertain and viability cannot be uniformly defined.

Recent findings: Recent literature highlights that outcomes during periviability depend on a constellation of factors, including gestational age, fetal weight, institutional resources, and access to neonatal intensive care. Advances in neonatal and obstetric care have pushed the threshold of viability earlier, but survival and morbidity remain highly variable. The diagnosis of life-limiting fetal anomalies or severe maternal complications during this time frequently necessitates urgent decision-making around abortion. Legal changes post-Dobbs have further complicated access to abortion care. Additionally, new recommendations surrounding feticidal injection are highlighted. Studies also emphasize that parental decisions are guided more by intuitive beliefs than by statistics alone, underscoring the importance of values-based counseling.

Summary: Periviability challenges clinicians to balance medical, legal, and ethical considerations while supporting patients through highly individualized, time-sensitive decisions. A shared decision-making model grounded in ethical principles is essential. Ongoing dialogue and refined, patient-centered guidelines are needed to ensure compassionate, equitable, and evidence-based care at the threshold of viability.