Pros and Cons of Preterm Labor Treatment

Abstract

In 1991 the New England Journal of Medicine reported on the survival of a newborn weighing only 280 g at birth (Muraskas et al. 1991). A 36-year-old woman pregnant for the first time after induced ovulation and homologous insemination achieved a triplet pregnancy. Two embryos were destroyed transabdominally using KCl solution in the tenth week of gestation. Growth and karyogram of the surviving fetus were normal. Severe preeclampsia developed. At 26 + 6 weeks the Doppler blood flow examination showed an enddiastolic stop. Due to this indication a cesarean section was performed. The newborn female showed signs of severe symmetric intrauterine retardation with a weight of 280 g and a body length of 25 cm; the Apgar score was 6 at 1 min and 9 at 5 min. After spending 120 days in the neonatal intensive care unit, the baby was sent home weighing 1900 g and with a length of 41 cm. After a year had passed she weighed 4390 g and was 61 cm in length; all values below the fifth percentile; at the neuropediatric follow-up examination she was found to have a mild developmental delay relative to her adjusted age. This example illustrates a large number of the legal and ethical problems of perinatal medicine which today influence the work in obstetrical and neonatological departments.