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4 - Fetal outcome following preterm delivery

Published online by Cambridge University Press:  07 August 2009

By
Malcom Levene  and
Lawrence Miall
Edited by
Jane Norman  and
Ian Greer
Malcom Levene
Affiliation:
The General Infirmary at Leeds
Lawrence Miall
Affiliation:
The General Infirmary at Leeds
Jane Norman
Affiliation:
University of Glasgow
Ian Greer
Affiliation:
University of Glasgow
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Summary

Introduction

Severe prematurity is the commonest cause of death and disability in perinatal medicine. It is essential to provide parents whose baby is at risk of being delivered extremely prematurely with an accurate and honest assessment of their baby's chance of survival and, if the child does survive to go home, inform them of the risk of severe disability in later life. With increasing survival of very immature babies the focus has shifted, to an extent, to discussions with the parents of whether the child is likely to be disabled and the severity of any subsequent disability. Predictions of severe disability, including cerebral palsy, severe learning problems, blindness and deafness, are reasonably accurate on a statistical basis, but in recent years it has become increasingly apparent that babies who survive into childhood with no severe neurological disability may show significant problems at school age, and these may, in turn, cause considerable distress to the family. This chapter reviews the best evidence on risk of death and disability in severely prematurely born babies.

The chapter is divided into five sections including a general critique of preterm delivery outcome studies, as well as reviews of mortality, severe disability, less severe short-term morbidity and long-term outcome into adolescence.

Methodology of outcome reviews

The medical literature on survival and disability rates varies considerably and this variation is dependent on a number of methodological factors.

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Type
Chapter
Information
Preterm Labour
Managing Risk in Clinical Practice
 , pp. 109 - 132
Publisher: Cambridge University Press
Print publication year: 2005

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