Obstetric management and counseling for threatened periviable birth.

PURPOSE OF THE REVIEW: Improving survival rates for extremely preterm infants have shifted the threshold for postnatal intervention earlier, although outcomes remain uncertain. Counseling for families facing periviable birth is complex, requiring integration of evolving data, ethical considerations, and patient values. Obstetricians play a key role in this counseling. This review synthesizes recent evidence on obstetric interventions at periviability, alongside best practices for counseling.

RECENT FINDINGS: Emerging data demonstrate improving survival at 22-23 weeks, although outcomes vary, highlighting the importance of using up-to-date, institution-specific outcomes in counseling. Obstetric management, including antenatal corticosteroids and mode of delivery, plays a critical role in influencing neonatal outcomes and should be integrated into counseling. Shared decision-making remains central but is challenged by prognostic uncertainty and differing values. In addition, counseling is further shaped by tone, language, and framing of the data presented. Structured counseling tools and multidisciplinary approaches may improve consistency and comprehension but remain underutilized.

SUMMARY: Periviability care requires integration of evidence-based obstetric management with patient-centered counseling. A multidisciplinary, emotionally attuned approach is essential to support shared, value-concordant decisions. Future efforts should focus on optimizing counseling frameworks and expanding the use of decision support tools while preserving individualized care.