Management of Extremely Preterm Births in the Level III Maternity Unit atStrasbourg University Hospital Centre (CHU)

Introduction: Active management of extreme prematurity, defined as birth occurring before 26WG, has medical and familial repercussions on account of the uncertain future of these infants. The aim of this paper is to describe our experience in the obstetrical and paediatric management of extreme preterm births based on choices made by the families. Methods: We retrospectively included all infants born between 22WG and 25WG+6days in our level III maternity unit in the period from January 2010 to December 2014. These births were documented along with family choices, methods of obstetrical management and birth outcomes. Results: 166 infants were included. After 24WG, active management was requested by the parents in 90% of cases versus 13% at 23WG and none at 22WG. Corticosteroid therapy was administered in 0% of cases at 22WG, 19% at 23WG, 92% at 24WG and 94% at 25WG. Caesarean section was performed in 0% of cases before 24WG, 10% at 24WG and 48% at 25WG. Six per cent of infants at 22WG, 32% at 23WG, 89% at 24WG and 92% at 25WG were live births. The survival rate for infants admitted to neonatal intensive care was 17% at 23WG, 47% at 24WG and 71% at 25WG. Conclusion: Optimal management of extreme preterm births requires a solidly cooperative obstetrical-paediatric team guided by respect for parental choice.