Week 24: Viability

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This is your Pea in the Podcast for week 24 of your pregnancy. I'm Bonnie Petrie joined by Dr. Laurie Swaim, an obstetrician with Houston Women's Care Associates in Houston, Texas.

Pregnant women live by their milestones and this week is a big one, "24 weeks is when the baby is considered to be viable, which means that if it is born at this time it has a reasonable chance for survival. I'm not a neonatologist, nor do I pretend to be one, but the risk for morbidity is actually quite high at 24 weeks and certainly, certain hospitals count certain statistics, different statistics, but overall still 24 weekers do not necessarily do well and their survival is nowhere near 100%." Now a baby born at 24 weeks could have between a 10% to 70% chance of survival, a lot of factors impact that percentage, including why their mom might have gone into labor.

What does a baby born now look like? "They have very sort of transparent-like skin, very thin skin. They have little lanugo hairs all over. They're not 'not cute' but they would be a lot cuter if they had some meat on them. They are about a pound to a pound and a half, so that's what they look like. They move, they cry, although most of them unfortunately are on ventilators so they can't cry because there's a tube in their throat. They can't eat mostly because they don't know how to suck and their digestive systems aren't really mature enough yet, but that's okay because the neonatalologists know how to feed them."

Surviving the birth is just the first challenges a baby this premature would face, now what could happen that would cause a baby to be born so soon? "There's spontaneous preterm birth. Preterm birth the rate is about 8% in the country and that has not changed in a bazillion years. Part of the reason for that is first of all we have no idea what causes it so it's pretty hard to prevent. We know there's some associations but we don't know the actual trigger. Second of all there has been a boom of higher order multiples and one of the biggest risks of having higher order multiples, or even twins, is preterm birth. So preterm birth, premature rupture of the membrane which is then associated with premature birth, sometimes infection can be associated. Then there's some maternal disorders like severe hypertension or severe preeclampsia, there's other bad maternal cardiovascular disease, bad lupus, those types of things that may make either the mom very sick or bedridden or the baby so, so small that it's doing so poorly in utero that it would do better exutero. That's pretty unusual for 24 weeks but that could certainly happen later on. I suppose a mom could have placenta previa and start bleeding out but once again that's pretty unusual at 24 weeks. The list is very, very long but those would be some of the more common reasons why a woman would deliver a 24 weeker."

As Dr. Swaim mentioned a mom could deliver at 24 weeks if her water breaks, that's called PROM or Premature Rupture of the Membranes, "The American College of OBGYNs does not recommend using is what we call tocolitic medications to try and prevent in women with premature rupture in their brains and that's something to which I subscribe. There are however some physicians who do use tocolitics and it is just really controversial. What we do is we do give the mom steroids, unless there are contraindications, of which I can think of none, to try to enhance the baby's lung maturity we use some antibiotics because there is a certain regimen of antibiotics that has been shown to increase the latent phase, but we only have so many tricks up our sleeve. If you're going to go into full blown labor, Bonnie, there's nothing we can do to stop you." But particularly if your water hasn't broken some doctors may stop your progression toward labor. "If there's true cervical changes, cervical dilatation, there are some medications that we can try. Whether they work or not is somewhat controversial." Now one of the biggest concerns for a baby born this early is lung development, these little ones are just starting to make surfactant which is essential to working lungs, "that's one of the reasons why we try and get steroids on board and everyone is in agreement there that before 34 weeks steroids are helpful when the bag water is intact and before 32 weeks when there are ruptured membranes." The steroid shots speed up a preterm baby's lung development; this decreases the risk of respiratory distress syndrome after birth. Certainly a baby born at this milestone week of viability would face many struggles, struggle to survive outside the womb, a struggle to stay alive in the weeks and months after birth. A good estimate is that a baby born now would usually stay in the neonatal intensive care unit until their official due date. They would face the struggle associated with the very high likelihood of like long handicaps that often come with extreme prematurity. But this milestone does ease the mind of many a mom-to-be. If your baby's born right now, it could live.

But we don't want the bean to come today. One source every day your baby stays in there baking increases their survival rate approximately 3% during weeks 23 through 26. Dr. Swaim says any extra weeks in there make a huge difference in the lives of babies. "I know we hear about it from our neonatologists annually, 'we had this many babies who were 24 weeks and this is what happened to them' and what have you. Every week makes a humongous difference. The difference between a 26 weeker and a 24 weeker is huge." After 26 weeks the survival rate generally jumps from 80% to 90%, that is something to look forward to.

So what is your baby busy doing in there this week? Well blood vessels are developing in the lungs, they're working on those beautiful long eyelashes and they're starting to produce white blood cells with which to fight disease and infection. You, my dear, may be struggling with what is known to the mommy-to-be world as pregnancy brain; you can't seem to hold a thought in your head, can you? You found your keys in the refrigerator and your tube of butter in the car. Yeah I know what you're talking about, you haven't lost your mind though, you're just pregnant. In fact, you're 24 weeks pregnant with 16 weeks to go until week 40.

That's your Pea in the Podcast for week 24 of your pregnancy. Dr. Swaim and I look forward to talking to you again next week. Enjoy this week. For a transcript of any of our Pea in the Podcasts go to our website peainthepodcast.com. For Pea in the Podcast, I'm Bonnie Petrie, thanks for listening.