Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

Background: Countries vary on the demarcation gestational age that distinguishes miscarriage and extreme preterm birth (PTB). This study provides a synopsis of the outcome of pregnancy between 22 to <28 weeks’ gestation from a low resource setting. Methods: A retrospective record review of a refugee and migrant population on the Thailand-Myanmar border with outcome between 22 to <28 weeks’ gestation, was conducted. Outcomes were classified as miscarriage: non-viability prior to 22 week’s gestation with expulsion of products between 22 to < 28 weeks’ gestation; or extreme PTB when the fetus was viable at ≥22 weeks and delivered between 22 to < 28 weeks’ gestation. Termination of pregnancy and gestational trophoblastic disease were excluded. Results: From 1995-2015, outcomes occurred between 22 to <28 weeks’ gestation in 0.9% (472/49,931) of pregnancies and 3.8% (18/472) met the exclusion criteria. Most included pregnancies (n=454) had ultrasound done 72.5% (n=329). Overall 43.6% (n=197) were miscarriage and 56.4% (n=257) extreme PTB. Miscarriage (late expulsion) between 22 to <28 weeks was observed with non-viability occurring at an estimated median gestation of 16 weeks. For cases with available data (n=252, 5 missing) the proportion of stillborn was 47.6% (n=120), liveborn 52.4% (n=132); and congenital abnormality 10.5% (24/228, 29 missing). Neonatal death was high 98.5% (128/131, 1 missing). Introduction of ultrasound was associated with a 2-times higher odds of classification of outcome as birth rather than miscarriage. Conclusion: In this low resource setting <1% of pregnancy outcomes occur in the 22 to <28 weeks’ gestation window; nearly half  were miscarriage; and neonatal mortality approached 100%.  In the scale-up to preventable newborns deaths, at least initially, greater benefits will be obtained by focusing on the greater number of viable newborns with a gestation of 28 weeks or more.

Original publication

DOI

10.12688/wellcomeopenres.10352.2

Type

Journal

Wellcome Open Research

Publisher

F1000 Research Ltd

Publication Date

19/07/2018

Volume

1

Pages

32 - 32