Management of the extreme premature delivery.

Generally speaking the answer, how early is too early, can't be exactly answered. For practical reasons it seems advisable to draw that line about 25 completed weeks of gestation but of course it is desirable to make individual decisions in each case when time and experience allows that. If possible, mothers with threatening very premature delivery should be transported to a stage 3 hospital. When one is prepaired to make maximal efforts for the survival of the infant, modern supervision of the fetus should be applied. In uncomplicated cases of idiopatic premature labour vaginal delivery should be allowed. Due to the fragility of the immature fetus any kind of birth trauma should be minimized. Caesarean section might be used on liberal indications and cases with beginning acidosis should be promptly delivered in the most suitable way. When complicated by breech presentation the delivery seems to be best performed by the abdominal route. I like to emphasize that to me, the most important item concerning the management of the very preterm birth is the correct dating of the pregnancy. Without reliable data one can hardly make any proper decisions on how early is too early and solve the problems connected to that question. In my opinion the emergency weight estimation with ultrasound is not satisfactory, only the knowledge of the length of the pregnancy allows you to do so.