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Considerations for obstetric management of births 22–25 weeks’ gestation

Journal of Perinatology (2025)Cite this article

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Abstract

Preterm birth between 22 and 25 5/7 weeks complicates <1% of live births within the United States though contributes more than 20% of infant mortality within the first year of life. Ante- and intrapartum interventions such as antenatal corticosteroids, magnesium sulfate, and tocolytic and antibiotic therapies have been shown effective in optimizing postnatal prognosis in births at 24 weeks and beyond. Interventions, mode of delivery, and resuscitation plans should ideally be discussed with the perinatology, neonatology, and nursing teams with the family using shared decision making. Observational data have alluded to similar postnatal benefits in births at 22–23 weeks; however, these data are limited by small sample sizes, inconsistencies in outcome reporting, and variations in management strategies. Future studies to evaluate the utility of these interventions among births at 22–23 weeks are warranted.

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Authors and Affiliations

  1. Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston, Houston, US

    Felicia V. LeMoine

  2. Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA

    Ashley N. Battarbee

  3. Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA

    Colm P. Travers

  4. Section of Neonatal Medicine, School of Public Health, Imperial College London, London, UK

    Cheryl Battersby

  5. Centre for Paediatrics and Child Health, Imperial College London, London, UK

    Cheryl Battersby

  6. Department of Reproductive Biology, The MetroHealth System/ Case Western Reserve University, Cleveland, OH, USA

    Kelly S. Gibson

  7. University of Texas Houston, Houston, TX, USA

    Matthew A. Rysavy

  8. University of Cologne, Köln, Germany

    Angela Kribs

  9. University of Iowa, Iowa City, IA, USA

    Edward F. Bell

  10. Kyorin University, Tokyo, Japan

    Satoshi Kusuda

  11. Duke University Hospital, Durham, NC, USA

    Noelle Younge

  12. Uppsala University, Uppsala, Sweden

    Johan Agren

  13. Parent Representative, Ames, IA, USA

    Kourtney Vier

  14. Nationwide Children’s, Columbus, Columbus, OH, USA

    Carl H. Backes

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  1. Felicia V. LeMoine
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  2. Ashley N. Battarbee
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  3. Colm P. Travers
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  5. Kelly S. Gibson
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the Tiny Baby Collaborative Steering Committee

  • Matthew A. Rysavy
  • , Angela Kribs
  • , Edward F. Bell
  • , Satoshi Kusuda
  • , Noelle Younge
  • , Johan Agren
  • , Ashley N. Battarbee
  • , Kourtney Vier
  •  & Carl H. Backes

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FL contributed to data curation, and manuscript writing, review, and editing. AB, CT, CB, and KG contributed to data contribution and manuscript review and editing. All authors have read and approved the final manuscript.

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Correspondence to Felicia V. LeMoine.

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LeMoine, F.V., Battarbee, A.N., Travers, C.P. et al. Considerations for obstetric management of births 22–25 weeks’ gestation. J Perinatol (2025). https://doi.org/10.1038/s41372-025-02289-y

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