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Key messages

Decision making for births at 22+0 to 24+6 weeks’ gestation presents clinical and ethical challenges.

Babies born between 22+0 and 23+6 may fall within the zone of parental discretion where parental wishes may determine the level of care provided. 

In addition to gestational age, consider other important determinants of outcome including:

  • place of birth (tertiary versus non-tertiary)
  • antenatal corticosteroid exposure
  • birthweight
  • plurality 
  • sex.

Consider active management following live birth (resuscitation, neonatal intensive care admission) from 22 weeks – but only in ideal circumstances, such as for babies born in a tertiary (Level 6) perinatal centre, and for babies free of adverse perinatal risk factors.

On this page

    In June 2023, we commenced a project to review and update the Maternity and Neonatal eHandbook guidelines with a view to completion in 2024. Please be aware that pending this review, some of the current guidelines may be out of date. In the meantime, we recommend that you also refer to more contemporaneous evidence.

    Over the past four decades, the gestational age at which active management and neonatal intensive care is considered appropriate has steadily decreased.

    Advances in antenatal and postnatal care have led to increased survival rates and improved long-term outcomes for infants who receive intensive care.

    These advancements require us to regularly review and update our perinatal guidelines.

    New guidance on extreme prematurity

    This guideline provides evidence-based guidance for managing labour and immediate care of the newborn infant at 22+0 to 24+6 weeks’ gestation. It includes active management and palliative care, and addresses decision making in the zone of parental discretion.

    Download the guidance

    When using this guideline, please consider each woman’s individual circumstances and risk factors when making decisions about the birth and care of the newborn infant.

    Management flowcharts

    To be used in conjunction with this guidance, you can download:

    Parent information sheets

    Parents facing the unexpected birth of their baby at extremely preterm gestations often find it difficult to recall everything covered during counselling sessions, given this is an extremely stressful situation.

    Our information sheets for parents of babies born at 22, 23 and 24 weeks’ gestation are designed to provide parents with written information following counselling about management options for their baby. They are not designed to be given to parents without counselling from their healthcare team in the first instance.


    Get in touch

    Clinical Guidance Team
    Safer Care Victoria

    Version history

    Due for review: November 2023

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