Aggressive obstetric management in late second-trimester deliveries.

A 3-year experience during which fetal welfare was a major factor in the management of patients delivering between 24 and 27 weeks' gestation is presented. Sixty-two cases of women for whom prenatal assigned gestational age was between 24 and 27 weeks and who had a live fetus on admission were reviewed. Using discharge from the hospital as definition for survival, 34 of the 62 infants (55%) survived. Survival rates ranged from 36% at 24 weeks' gestation to 76% at 27 weeks' gestation. Three of the 34 survivors had major continuing problems at discharge. Of the various strategies used to improve perinatal outcome, the antenatal administration of betamethasone was associated with a significant (P less than .03) improvement in infant survival. The authors are encouraged by these results, which indicate that aggressive antenatal and postnatal efforts for pregnancies with gestational ages between 24 and 27 weeks are cost-effective, productive, and worthwhile.