Premie vs. "Miscarriage"

icesk8ie · Nov 23, 2003

I am really not the expert on this subject, but I am in my Women's Rotation right now. We have been taught that the age of viability is 20 weeks gestational age, even though I believe it is very rare to have such a premie survive. Miscarriage before 20 weeks, premature at 20 weeks and beyond.

cswain12000 · Nov 23, 2003

20 weeks is not viable--earliest viability with any hope for a decent outcome is 23 weeks, and that is "iffy" and a long hard road for parents and baby.

BETSRN · Nov 23, 2003

The tiertiary care center we use will not accept anyone under 24 weeks. I think you are mistaken with the idea that 20 weeks is viable. It is not. Most OB units have to take problem pregnancies greater than 20 weeks (UTI's bleeds etc), but that's a whole different thing than thinki g viability at 20 weeks. They are not viable at that early a gestational age.

dawngloves, BSN, RN · Nov 23, 2003

25 weeks? Not a miscarriage where I come from.

20 weeks? Yeah, that's a miscarriage.

mother/babyRN, RN · Nov 23, 2003

20 weeks is absolutely not viable. Occasionally under some circumstances 23 or 24 weekers have a small chance of surviving, albeit often with major disabilites....However, in Massachusetts we cross the line from miscarriage ( or demise) to stillbirth, at 20 weeks...Before 20 weeks or under 1500 grams, it is considered a miscarriage and over either of those two parameters, it is considered a still birth or demise...It is not an issue so much of hesitating to intervene at 20 , 21 or 22 weeks..These children are not viable....Only in recent years have 23 weeks been doing occasionally well. I think it is insulting and just plain wrong to assume that nurses ( and I can speak only FOR nurses) would routinely or even rarely sacrifice someone due to the assumption that an infant or fetus isn't viable. Most of us are hugely upset whatever the gestational age of the fetus...You hear their heartbeats...You know the sadness and the grief..

Whoever has an ionstructor telling them that a 20 week fetus is viable, is grossly misinformed and just plain wrong..

TonyafutureRN · Nov 23, 2003

I too have read in books that 20 weeks + is considered a "premature birth" instead of a "miscarriage", although I know 23 weeks is usually the minimum for having a baby possibly survive with an extended NICU. I thought that was strange too. It seems like "premature birth" would mean that the baby has a chance of survival. My dr also told me that before 20 weeks they don't do anything to try to stop labor if a woman goes into labor because the baby is not considered viable (and I suppose the damage to the baby from the drugs would be greater in one that young???) Maybe that is the difference? I'm not an OB nurse, I'm just typing what I've heard, I don't know if it's right or not. Tonya

NICU_Nurse, BSN, RN · Nov 23, 2003

20 weeks is absolutely not viable. I've seen 22 3/7 weekers tubed and sent to the NICU and every one of them died. The 23 weekers, as someone else mentioned, have a very long road ahead of them- amazing what three days and unknown circumstances can mean as far as viability is concerned, isn't it?

I think the idea is that if a 20 weeker were to pop out, the baby wouldn't be considered viable, and thus would be termed a miscarriage. However, if a mom at 20 weeks goes into pre-term labor, I believe it is then that the MD's would start trying to prolong it and really intervene to get her up to 23 weeks minimum before having to deliver the baby, allowing the baby to get those crucial 14-21 days in for extra development and an extra chance at life. I have NEVER seen anyone try to resuscitate a baby less than 22 weeks- even the smallest laryngoscope is monstrous for those babies. They don't even make equipment that tiny!

I am sick to death of MD's intervening and resuscitating when they shouldn't, but that's another subject. I'm tired, sorry. :) Grumpy this morning, I guess.

SmilingBluEyes · Nov 23, 2003

Originally posted by NICU_Nurse
20 weeks is absolutely not viable. I've seen 22 3/7 weekers tubed and sent to the NICU and every one of them died. The 23 weekers, as someone else mentioned, have a very long road ahead of them- amazing what three days and unknown circumstances can mean as far as viability is concerned, isn't it?

I think the idea is that if a 20 weeker were to pop out, the baby wouldn't be considered viable, and thus would be termed a miscarriage. However, if a mom at 20 weeks goes into pre-term labor, I believe it is then that the MD's would start trying to prolong it and really intervene to get her up to 23 weeks minimum before having to deliver the baby, allowing the baby to get those crucial 14-21 days in for extra development and an extra chance at life. I have NEVER seen anyone try to resuscitate a baby less than 22 weeks- even the smallest laryngoscope is monstrous for those babies. They don't even make equipment that tiny!

I am sick to death of MD's intervening and resuscitating when they shouldn't, but that's another subject. I'm tired, sorry. :) Grumpy this morning, I guess.

I don't see ya as grumpy....this sums up how I feel VERY nicely. And where I work, it's not called a miscarriage either, it's a fetal or neonatal DEMISE (depending on when death occurs).

NICU_Nurse, BSN, RN · Nov 23, 2003

:kiss

You don't see me as grumpy because I deleted and re-phrased the last part of my post.

LilgirlRN, ADN, RN · Nov 23, 2003

I work in the ED doing triage. We see a lot of miscarrying women. I am working at a new job, been there abougt 6 weeks. Everywhere else I have worked we sent >20 weeks to L&D. Here if they are more than 16 weeks then they go to L&D. I don't get it but don't feel like I've been there long enough to question anything. Plus the fact that many ED nurses would see it as a way to not have to take care of another patient, which sounds harsh but we have to take care of sooooooo many patients. I like to put patients where they belong, a 16 weeker doesn't belong in L&D IMO.

L&D_RN_OH · Nov 23, 2003

I think what icesk8ie probably meant was

I think that if the doc (and everyone else) in this case agreed that 24 wks is viable, then they definitely should have taken action much faster than they did. I can see wht you would be upset about it.

We had a 22 wker carrying twins come in a few weeks with SROM of one twin. I thought we should do something, since at least one twin was still fine. I'm not sure what we could have done, tocolytics, amnioinfusion........ who knows. We ended up doing nothing. She delivered one dead twin the next night, and the other twin the morning after. On top of that, she had a fetal demise at 38 wks the year before.