Cesarean Delivery at the Edge of Viability – University Faculty for Life

The Pain-Capable Unborn Child Protection Act passed this year in four states (Alabama, Idaho, Kansas, & Oklahoma). It prohibits performance of abortions from 20 weeks post-fertilization (22 gestational weeks) unless necessary to protect the life or physical health of the mother. The tfollowing report notes that children born at this early age via ceasarean have a better chance of survival.

Cesarean Delivery at the Edge of Viability

The number of cesarean deliveries at extremely early gestational ages is growing; clinical conditions rather than race or ethnicity influence delivery mode.

Rates of extremely preterm birth have risen during the past 2 decades. Advances in neonatal care improve the likelihood of survival for infants born at the cusp of viability, but with such advances comes the temptation to offer ever more interventions. Now, one group of investigators has assessed U.S. cesarean delivery rates in periviable neonates during a 6-year period, and another group has examined whether racial or ethnic disparities in the rates of such deliveries are evident.

From 1999 through 2005, <1% of infants were born at 22 to 28 weeks’ gestation; however, whereas rates of all births rose by 4% during this period, rates of extremely premature births rose by 7%. Cesarean delivery rates in extremely preterm infants rose from 43% in 1999 to 54% in 2005, but without an accompanying improvement in infant mortality (24% to 26%). When predictors of cesarean delivery at gestational ages from 23 to 24.6 weeks in three U.S. states from 1995 to 2005 were reviewed, neither race nor ethnicity was a significant predictor of delivery mode; rather, medical conditions were the most prominent factors. In particular, women with pregnancy-induced hypertension had almost 16-fold higher odds of cesarean delivery than did women without hypertension.

Comment: Although we have no clear evidence that cesarean delivery improves survival at the border of fetal viability, the percentage of women who undergo this procedure at early gestation is rising. Infants born by cesarean delivery have lower risk for death than do those born vaginally, but this difference likely reflects choices about which patients are offered cesarean delivery rather than survival advantages conferred by this mode of delivery itself. Cesarean delivery seems to be offered equitably across races and ethnicities. Overall, the rise in cesarean delivery rates at very early gestational ages raises important questions about how delivery mode is determined.

— Allison Bryant, MD, MPH

Published in Journal Watch Women’s Health July 21, 2011

Citation(s):

Batton B et al. Extremely preterm infant mortality rates and cesarean deliveries in the United States. Obstet Gynecol 2011 Jul; 118:43.

Medline abstract (Free)

Tucker Edmonds B et al. Predictors of cesarean delivery for periviable neonates. Obstet Gynecol 2011 Jul; 118:49.

Medline abstract (Free)

Teresa Collett

Teresa Stanton Collett is a professor at the University of St. Thomas School of Law in Minneapolis, Minnesota, where she teaches bioethics, property law, and constitutional law. A nationally prominent speaker and scholar, she is active in attempts to rebuild the Culture of Life and protect the institutions of marriage and family. She often represents groups of state legislators, the Catholic Medical Association, and the Christian Medical and Dental Association in appellate case related to medical-legal matters. She represented the governors of Minnesota and North Dakota before the U.S. Supreme Court as amici curiae regarding the effectiveness of those states’ parental involvement laws. She has served as special attorney general for Oklahoma and Kansas related to legislation designed to protect the well-being of minors and unborn children. She is an elected member of the American Law Institute and has testified before committees of the U.S. House of Representatives and U.S. Senate Committee on the Judiciary, Subcommittees on the Constitution, as well as numerous legislative committees in the states.