Delivery of the preterm low birth weight singleton fetus
- Jane Cleary-Goldman, MD
Jane Cleary-Goldman, MD
- Assistant Clinical Professor of Obstetrics and Gynecology
- Mount Sinai Medical School
- Julian N Robinson, MD
Julian N Robinson, MD
- Associate Clinical Professor of Obstetrics and Gynecology
- Harvard Medical School
Delivery of the preterm low birth weight (LBW) fetus is often necessitated by maternal and fetal indications, including nonreassuring fetal status, intractable preterm labor, intraamniotic infection, placental abruption, placental insufficiency, hypertensive disorders, and other maternal factors (see individual topic reviews on these subjects). The prognosis for survival and long-term outcomes of these neonates continues to improve and can be attributed, in part, to widespread use of antenatal corticosteroids in women at risk for preterm birth, liberal use of cesarean delivery for fetal indications, improvements in neonatal resuscitation, use of surfactant therapy, magnesium sulfate prophylaxis, and delivery at facilities with personnel experienced in neonatal intensive care. (See "Incidence and mortality of the preterm infant".)
DEFINITION OF LOW BIRTH WEIGHT
Low birth weight neonates are subgrouped according to the degree of smallness at the first weight determination after birth :
●Low birth weight (LBW): less than 2500 grams
●Very low birth weight (VLBW): less than 1500 grams
●Extremely low birth weight (ELBW): less than 1000 grams
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- DEFINITION OF LOW BIRTH WEIGHT
- CHOOSING THE ROUTE OF DELIVERY
- Cesarean versus vaginal
- Spontaneous vaginal versus assisted vaginal
- INTRAPARTUM ISSUES
- Neonatology consultation
- Intrapartum fetal monitoring
- Maternal analgesia/anesthesia
- Use of episiotomy, vacuum, and forceps
- Optimal cord clamping
- Techniques for atraumatic cesarean delivery
- MANAGEMENT AT THE LIMIT OF VIABILITY
- SUMMARY AND RECOMMENDATIONS