{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T16:43:50Z","timestamp":1791045830115,"version":"4.1.0"},"reference-count":0,"publisher":"SMW Supporting Association","issue":"4142","license":[{"start":{"date-parts":[[2011,10,10]],"date-time":"2011-10-10T00:00:00Z","timestamp":1318204800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Swiss Med Wkly"],"abstract":"<jats:p>Perinatal  care of pregnant women at high risk for preterm delivery and of preterm infants  born at the limit of viability (22\u201326\u00a0completed weeks of gestation) requires a  multidisciplinary approach by an experienced perinatal team. Limited precision  in the determination of both gestational age and foetal weight, as well as  biological variability may significantly affect the course of action chosen in  individual cases.\n        The  decisions that must be taken with the pregnant women and on behalf of the  preterm infant in this context are complex and have far-reaching consequences.  When counselling pregnant women and their partners, neonatologists and  obstetricians should provide them with comprehensive information in a sensitive  and supportive way to build a basis of trust. The decisions are developed in a  continuing dialogue between all parties involved (physicians, midwives, nursing  staff and parents) with the principal aim to find solutions that are in the  infant\u2019s and pregnant woman's best interest.\n        Knowledge  of current gestational age-specific mortality and morbidity rates and how they  are modified by prenatally known prognostic factors (estimated foetal weight,  sex, exposure or nonexposure to antenatal corticosteroids, single or multiple  births) as well as the application of accepted ethical principles form the  basis for responsible decision-making. Communication between all parties  involved plays a central role.\n        The  members of the interdisciplinary working group suggest that the care of preterm  infants with a gestational age between 22\u00a00\/7 and 23 6\/7 weeks should generally  be limited to palliative care. Obstetric interventions for foetal indications  such as Caesarean section delivery are usually not indicated. In selected cases, for  example,  after 23 weeks of pregnancy  have been completed and several of the above mentioned prenatally known  prognostic factors are favourable or well informed parents insist on the  initiation of life-sustaining therapies, active obstetric interventions for  foetal indications and provisional intensive care of the neonate may be  reasonable.\n        In preterm  infants with a gestational age between 24 0\/7 and 24 6\/7 weeks, it can be  difficult to determine whether the burden of obstetric interventions and  neonatal intensive care is justified given the limited chances of success of  such a therapy. In such cases, the individual constellation of prenatally known  factors which impact on prognosis can be helpful in the decision making process  with the parents.\n        In preterm  infants with a gestational age between 25 0\/7 and 25 6\/7 weeks, foetal  surveillance, obstetric interventions for foetal indications and neonatal  intensive care measures are generally indicated. However, if several prenatally  known prognostic factors are unfavourable and the parents agree, primary  non-intervention and neonatal palliative care can be considered.\n        All  pregnant women with threatening preterm delivery or premature rupture of  membranes at the limit of viability must be transferred to a perinatal centre  with a level III neonatal intensive care unit no later than  23 0\/7 weeks of gestation, unless emergency  delivery is indicated. An experienced neonatology team should be involved in  all deliveries that take place after 23\u00a00\/7 weeks of gestation to help to decide  together with the parents if the initiation of intensive care measures appears  to be appropriate or if preference should be given to palliative care (i.e., primary  non-intervention). In doubtful situations, it can be reasonable to initiate  intensive care and to admit the preterm infant to a neonatal intensive care  unit (i.e., provisional intensive care). The infant\u2019s clinical evolution and  additional discussions with the parents will help  to clarify whether the life-sustaining therapies  should be continued or withdrawn.\n        Life  support is continued as long as there is reasonable hope for survival and the  infant\u2019s burden of intensive care is acceptable. If,\u00a0on the other hand, the  health care team and the parents have to recognise that in the light of a  very poor prognosis the burden of the   currently used therapies has become disproportionate, intensive care  measures are no longer justified and other aspects of care (e.g., relief of  pain and suffering) are the new priorities (i.e., redirection of care). If\u00a0a  decision is made to withhold or withdraw life-sustaining therapies, the health  care team should focus on comfort care for the dying infant and support  for the parents.<\/jats:p>","DOI":"10.4414\/smw.2011.13280","type":"journal-article","created":{"date-parts":[[2011,10,27]],"date-time":"2011-10-27T03:48:08Z","timestamp":1319687288000},"page":"w13280","source":"Crossref","is-referenced-by-count":26,"title":["Perinatal  care at the limit of viability between 22 and 26\u00a0completed weeks of gestation  in Switzerland"],"prefix":"10.57187","volume":"141","author":[{"given":"Alama","family":"El","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I","family":"H\u00f6sli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Nelle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Surbek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Wisser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"Zimmermann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JC","family":"Fauch\u00e8re","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AC","family":"Truttmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"36756","published-online":{"date-parts":[[2011,10,10]]},"container-title":["Swiss Medical Weekly"],"original-title":[],"link":[{"URL":"https:\/\/smw.ch\/index.php\/smw\/article\/download\/1362\/1608","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/smw.ch\/index.php\/smw\/article\/download\/1362\/1609","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/smw.ch\/index.php\/smw\/article\/download\/1362\/1608","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T03:12:21Z","timestamp":1755227541000},"score":1,"resource":{"primary":{"URL":"https:\/\/smw.ch\/index.php\/smw\/article\/view\/1362"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2011,10,10]]},"references-count":0,"journal-issue":{"issue":"4142","published-online":{"date-parts":[[2011,10,10]]}},"URL":"https:\/\/doi.org\/10.4414\/smw.2011.13280","relation":{},"ISSN":["1424-3997"],"issn-type":[{"value":"1424-3997","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,10,10]]}}}