Counseling and management of women at risk for delivery near the limit of viability (the "periviable period" at 200/7 through 256/7 weeks' gestation) remains one of the most challenging issues faced by obstetricians and neonatologists. Complex and ethically challenging issues often heed to be considered, and difficult decisions need to be made quickly in evolving circumstances. Among the issues are; determination of potential viability, administration of tocolytic agents to prolong pregnancy, antenatal steroids to advance fetal maturation, magnesium sulfate for neuroprotection, intrapar-tum fetal monitoring, and cesarean delivery. The risk of these interventions to the mother in the current and future pregnancies are of particular concern.
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