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Minerva Medicolegale 2007 June;127(2):105-36

Copyright © 2007 EDIZIONI MINERVA MEDICA

language: Italian

Resuscitation of the extremely preterm neonate and obstetric care. Clinical, ethical and legal implications

Massimelli M. ¹, Martano C. ², Gianotti C. ³, Iorio M. ¹

¹ Dipartimento di Anatomia Farmacologia, Medicina Legale Università degli Studi di Torino, Torino 2 Dipartimento di Neonatologia OIRM-S.Anna Università degli Studi di Torino, Torino 3 Corso di Laurea di Ostetrica Università degli Studi di Torino, Torino

This article examines the clinical, ethical and legal implications of resuscitation of the extremely preterm neonate (22-25 weeks gestations) delivered by unstoppable labor or induced labor for therapeutic interruption of pregnancy. The clinical implications are examined and then integrated with a review of the literature and the results of a studio on the survival (67.6% of the sample) and outcome of extremely low birth weight infants who received intensive care at the Azienda Ospedaliera OIRM – S. Anna, Torino, between 2003 and 2005. The ethical and legal implications lead into a proposal for amending Law 194/1978 in light of current clinical practice and socio-medical context: maximum threshold for therapeutic interruption of pregnancy set at 23 weeks gestation (22 weeks and 6 days). The results of this multicenter multidisciplinary study (obstetrics, resuscitation, neonatalogy, ethics, law and legal medicine) suggest that care appropriate to the condition and vitality of the individual infant (23 weeks gestational age) be given, whereas compassionate care should be reserved for neonates <23 weeks gestational age.