What does viability week mean in pregnancy

According to Websters Encyclopedic Unabridged Dictionary of the English Language, viable of a fetus it means having reached such a stage of development as to be capable of living, under normal conditions, outside the uterus. Viability exists as a function of biomedical and technological capacities, which are different in different parts of the world. As a consequence, there is, at the present time, no worldwide, uniform gestational age that defines viability. Viability is not an intrinsic property of the fetus because viability should be understood in terms of both biological and technological factors. It is only in virtue of both factors that a viable fetus can exist ex utero and thus later achieve independent moral status. Moreover, these two factors do not exist as a function of the autonomy of the pregnant woman. When a fetus is viable, that is, when it is of sufficient maturity so that it can survive into the neonatal period and later achieve independent moral status given the availability of the requisite technological support, and when it is presented to the physician, the fetus is a patient. In the United States viability presently occurs at approximately 24 weeks of gestational age (Chervenak, L.B. McCullough; Textbook of Perinatal Medicine, 1998). In Portugal, the mortality increase significantly with GA<25 weeks. At 25 weeks mortality was 44.4% and at 26 weeks was 24.4% (I. Macedo et al. Matemidade Dr. Alfredo da Costa, Lisbon, 2000). In Poland during last years we observe also a very significant decrease of perinatal mortality. There are several aspects of fetal viability: ethical, social, psychological and medical. Ethical aspects There is a compelling conceptual and clinical reason to reject Primum non nocere as the primary principle of perinatal ethics; virtually all medical interventions involve unavoidable risks of harm, for example, amniocentesis. If Primum non nocere were to be made the primary principle of perinatal ethics, virtually all of perinatal medicine would be unethical. Social aspects Greatly increased advances in perinatal medicine lead on one hand to a high quality of care expected and demanded by both the health care professionals and patients, but on the other hand the resources available for responding to the expectations and demands are becoming increasingly stretched. Even in the high-income countries, the available resources are scarce in relation to these demands a high quality of care expected and demanded by both the health care professionals and patients, but on the other hand the resources available for responding to the expectations and demands are becoming increasingly stretched. Medical aspects During the preconceptional period the most important actions are: family planning, education, analysis of previous obstetrical miscarriages and prevention of congenital malformations (folic acid). Pregnancy presents several problems, which can significantly influence fetal viability. Proper management of these problems can improve perinatal outcome. Among others prevention of prematurity is the most important goal of contemporary perinatal medicine. Enhancement of fetal viability There are several possibilities to enhance fetal viability. The most important are: organization of perinatal care, introduction of new technologies to perinatal medicine, intensive fetal therapy and early detection of fetal distress. Three levels system of perinatal care, transport in utero, introduction and promotion of new methods, continues education of staff are characteristic for the modern organization of perinatal medicine. Echocardiography, Color Doppler Energy, 3D sonography, prenatal diagnosis (cordocentesis, analysis of fetal cells in maternal blood,.), fetal pulse oximetry, mathematical analysis of the signal are the methods which should be used at the highest level of perinatal care. Today, the prospect of survival is only about 1 in 10 at 23 weeks, and if the child lives it is more likely to be handicapped that not. At 24 weeks the chance of a normal survivor is about 50%, and after this the odds are in favor of a normal survivor. Considering this data, intensive care should be an optional choice for fetuses at 23 and 24 weeks of gestation and should be offered to every fetus at 25 weeks or more.

The fall of Roe v. Wade on June 24 marked the start of a strange era to be a Maternal-Fetal Medicine physician. By definition, we take care of anyone with a high-risk pregnancy, which can occur because the pregnant person has a medical condition such as diabetes or breast cancer or because something is wrong with the fetus genetically or anatomically, like a birth defect. As high-risk pregnancy physicians, we share the mantra that we hope for the best but prepare for the worst. Luckily, of the thousands of patients we have cared over the last 12 years, the majority have achieved our hope of the best: a relatively uneventful pregnancy and successful live birth. But, despite our best preparations, some have suffered the worst: we have mourned mothers who have died during pregnancy or childbirth and, with our patients, have mourned the loss of their highly desired pregnancies in the womb. For these reasons—not to mention the fundamental principal in medical ethics of patient autonomy (the right of patients to make their own decisions about their body, even if the doctor disagrees or the decision goes against medical advice)—abortion care goes hand-in-hand with high-risk pregnancy care.

In fact, many high-risk pregnancy providers also provide abortions for pregnancies that were initially highly desired, sometimes to save their patients’ lives and sometimes because their patient’s fetus has severe genetic abnormalities or birth defects incompatible with life after birth. Other times, we provide abortions because of complications like life-threatening vaginal bleeding, an abnormally dilated cervix, or broken bag of water during what is called the “previable period.”

To understand what the previable period is, we must first understand fetal viability. Fetal viability does not begin when the small collection of embryonic cells that may eventually become a heart starts pulsating at 6 or 7 weeks’ gestation. In medicine, fetal viability is defined as the point in pregnancy that survival is possible, should birth occur. Though there is no universal consensus, currently in the U.S., fetal viability is thought to be at approximately 6 months of pregnancy (23-24 weeks’ gestation), though some hospitals offer aggressive treatment for babies born at 22 weeks gestation and survival has been reported as early as 21 weeks. Despite rapid advancements in care for newborn babies over the last few decades, babies born before viability—even those at the cusp of viability—cannot survive after birth.

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As Maternal-Fetal Medicine physicians, we are geographically lucky: because we live in Rhode Island, which has already codified the legal right to abortion into state law, our ability to practice all aspects of high-risk pregnancy care, including offering and providing abortions, is unchanged. However, the post Roe v. Wade reality has dramatically affected our friends and colleagues practicing in states in which policy makers have already passed laws that make no medical sense. These laws prioritize the continuation of previable pregnancies—those that may have a heartbeat but have zero chance of survival should birth occur—above the health and autonomy of an actual, living pregnant person. Some of these laws do not make exceptions for ectopic pregnancies, which may have a heartbeat but are, by definition, located outside the uterus, are never viable at any gestational age, and are, in fact, life threatening to the pregnant person. (However, hospitals must provide abortions if the life of the mother is at risk, the Biden Administration declared July 11; in these cases federal law supercedes state abortion bans.)

Colleagues in these states describe that practicing obstetrics now feels like we are back in the Middle Ages. They have already watched women with previable pregnancies hemorrhage during an early pregnancy loss, waiting for either the embryo’s heart to stop beating or for the mother to lose enough blood to feel legally justified to proceed with a simple, safe procedure to remove the pregnancy tissue. They have watched women with previable pregnancies partially deliver fetuses through abnormally dilated cervices, again waiting for the fetal heart to stop beating or for the mother to be sick enough from a preventable infection to be legally justified to help what has started—a previable delivery—continue. They have also diagnosed serious fetal anomalies in highly desired pregnancies but can no longer offer an abortion as an option, even if the patient would have preferred to not continue the pregnancy.

Before June 24, 2022, these common clinical scenarios were already devastating for pregnant people. But the abolishment of Roe v. Wade has eliminated many of our patients’ agency about their pregnancies and reduced our ability as high-risk pregnancy providers to provide abortions when they are medically recommended or personally desired. The intentional decision of policymakers to prioritize the wellbeing of a previable fetus with a beating heart over the wellbeing of the pregnant person is not just medically incorrect, it is socially reprehensible with dire consequences.

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In general, infants that are born very early are not considered to be viable until after 24 weeks gestation. This means that if you give birth to an infant before they are 24 weeks old, their chance of surviving is usually less than 50 percent. 

Some infants are born before 24 weeks gestation and do survive. But these infants have a very high chance of severe long-term health problems. About 40 percent of these preemies will suffer long-term health complications because they were born prematurely.

The survival rate for 24-week-old infants is between 60 and 70 percent. 

But, a 24-week old preemie’s chance of dying goes down dramatically if a woman can stay pregnant for just two or three weeks longer. The preemie’s chances of having long-term health problems also decrease dramatically. 

Health Outcomes for 28-Week Old Preemies

Survival rates for infants born at 28 weeks gestation is between 80-90 percent. Babies born at 28 weeks old only have a 10 percent chance of having long-term health problems.

Health Outcomes for 32-Week Old Preemies

If a fetus reaches 32 weeks gestation and you deliver at 32 weeks gestation, your preemie’s chance of surviving is as high as 95 percent. Their chance of dying during infancy and childhood is also very low. 

Health Outcomes for 34-Week Old Preemies

Babies who are born after 34 weeks gestation have the same long-term health outcomes as babies who are delivered at full term (40 weeks). This means that if your baby is born when they are 34 weeks old, they have the same chances of being healthy as any other baby that wasn’t born prematurely.

But, it’s important to know that 34-week-old infants will probably need to stay in the hospital for one to two weeks in the Newborn Intensive Care Unit. In long-term follow-up, these infants do very well and usually are as healthy as non-preemies.

Any preemie that’s born earlier than 34 weeks gestation should spend several weeks in the NICU. On average, doctors recommend preemies stay in the NICU until three to four weeks before what their regular due date would have been. 

Lengthening Your Pregnancy By One or Two Weeks

If you’ve given birth a preemie before, you know the complications and problems that premature infants face. It’s important to keep in mind that for any future pregnancies, we don’t need to completely prevent preterm birth to have a positive impact on your child’s health.

If we can work with you to delay your delivery by as little as one or two weeks, you baby will have a much higher chance of staying healthy as they grow.