Talk:Fetal viability

Far too US centric

Does not look at Fetal viability around the world only looks at US legal definitions (where are UK/AUS/NZ?), does not have a table of Fetal viability age by country.

Any

Any objection to moving this from Viability (fetal) to Fetal viability ? Polarpanda (talk) 11:21, 7 December 2009 (UTC)

I think it and the cross-reference in fetal viability should remain. ElderHap (talk) 00:47, 3 February 2010 (UTC)

I tend to think the current name and associated disambiguations are fine. V (talk) 20:09, 9 June 2010 (UTC)

Viability and persons, and the future

If something is almost inevitable but doesn't exist yet, should the Law reflect it, or merely/only take into account the current state of affairs? The existence of the Moon Treaty implies that future abilities 'can be worthy of legal consideration here-and-now.

In the Roe vs Wade article it is indicated that the definition of the third trimester has become associated with viability. There is an aspect of that definition that I brought up in the Talk page there, and a suggestion was made that it be posted here also. Modern medical technology has, as stated in the article here, enabled unborn human bodies to be viable considerably earlier than in any of the many millennia during which that technology did not exist. This implies that as soon as someone successfully develops an artificial womb, even a just-fertilized human ovum could be considered viable. It therefore may be unwise to define the third trimester in terms of viability. Not to mention that I'm certain I had encountered a different definition that I don't-recall-precisely just now, and will have to look up --but I think it noted that at the start of the third trimester is when the brain connects to the spinal cord, and thereby becomes able to communicate with the rest of the body. This definition would be true regardless of available technology, so long as that tech didn't interfere with the natural and typical development process of the fetus.

Meanwhile, there is an aspect of viability to describe that has nothing to do with trimesters, but also involves technology. We just about have the ability to cut someone's head off and keep both it and the body alive, separately. There are actual situations I've read about where such a procedure might be the only way to save some person's life ( http://forum.ebaumsworld.com/showthread.php?t=268089&page=2 ). Barring such an emergency, depending on where the cut is made, it is possible that the body might be viable without significant life support. Reference: http://www.miketheheadlesschicken.org/ --the head, of course, would never be viable without a great deal of technological life support. Now, the reason I mention this has to do with a completely different topic of medical research: "regeneration". There is a large desire to be able to regrow lost limbs and so forth. Should such a medical breakthrough ever be achieved (and it is beginning to look inevitable: http://news.bbc.co.uk/2/hi/science/nature/4888080.stm ), then it should be possible for a detached head to grow a new body, and of course for a headless body to grow a new head. If we were asked which way to go, to save the life of a "person", which would we recommend? Is the headless body the person we want to save, or the mind inside the bodiless head? I think the answer is obvious, that the mind is the person and not the body. A headless body that grows a new head will become a different person altogether, just like twins are different persons (and clones will be different persons).

Now consider the position of some anti-abortionists, that if a fetus is viable it must be considered to be a person--do you see a problem with that, regarding bodiless-head persons and viability? It seems to me that one can only conclude that the two ideas of "person" and "viability" don't have to have anything to do with each other! Indeed, the fact that we use a lot of life-support technology to save people who have extensively damaged bodies (even when we know the bodies cannot naturally grow mostly-healthy again), but we eventually disconnect the brain-dead, only reiterates the idea that the concept of "person" is fundamentally dependent upon a significant amount of working brainpower, regardless of how viable are the attached bodies. Note that the field of science fiction has extensively discussed the idea of Artificial Intelligent Beings, having person-class brainpower but no biological viability at all. Ethical discussions already exist about whether or not turning off a genuine AI would be murder, and such discussions are likely to become legally relevant within twenty years, given Moore's Law and associated technological progress in computer science. All the preceding of which consequently means, for unborn human bodies, that viability should have nothing to do with any aspect of any abortion debate, ever. Because every fetus, up to and including late term births, has (provably) only animal-level brainpower, not person-level brainpower. V (talk) 20:09, 9 June 2010 (UTC)

It might now be noted that if regeneration technology and artificial wombs both exist, then the anti-abortion people could claim that every time anyone bleeds, simply because every lost white blood cell has the potential to, through regeneration, form a complete person, then every such white blood cell must be gathered up and allowed to grow in the artificial wombs. It is this sort of extreme-ism that can best show just how mistaken is the idea that "viability" should have anything to do with the concept of "person". V (talk) 18:40, 21 June 2010 (UTC)

Source was misrepresented

Moore and Persaud's book defines fetal viability on page 103, but does not make any claim about it being defined as survival without medical intervention. The relevant sentence is, "Viability is defined as the ability of fetuses to survive in in the extrauterine environment (i.e., after a premature birth)." Note the full stop: That's the whole definition. WhatamIdoing (talk) 20:45, 22 March 2010 (UTC)

Proposed page move

I propose to move this page from Viability (fetal) to Fetal viability. This just seems like a more natural title to me. Any thoughts? bd2412 T 15:50, 8 February 2011 (UTC)

Unbalanced towards certain viewpoints

This article purports to be about foetal or fetal viability. Currently, it opens with the following sentence:

Fetal viability is the ability of a fetus to survive outside the uterus.[1]

Following the wikilink for fetus in the opening sentence, one reads the first sentence on the fetus page which defines the meaning of fetus:

A fetus /ˈfiːtəs/, also spelled foetus, fœtus, faetus, or fætus, is a developing mammal or other viviparous vertebrate after the embryonic stage and before birth.

Thus, we learn in the first sentence of the article that all mammals (and other viviparous vertebrates) produce embryos that then (with the exception of marsupials) become foetuses (aka 'fetuses', North American spelling).

The viability of different species of foetus varies between mammalian species. Humans are just one species of mammal. This article needs therefore to be expanded to describe the foetal viability of foetuses generally, not merely the foetal viability of human foetuses. Currently, it concentrates entirely and exclusively on a description of the viability of the human foetus. This means that the article is unbalanced currently towards an anthropocentric viewpoint viz the Wikipedia template {{Unbalanced}} 58.164.138.229 (talk) 06:26, 18 June 2013 (UTC)

Thank you for your suggestion. When you believe an article needs improvement, please feel free to make those changes. Wikipedia is a wiki, so anyone can edit almost any article by simply following the edit this page link at the top.
The Wikipedia community encourages you to be bold in updating pages. Don't worry too much about making honest mistakes—they're likely to be found and corrected quickly. If you're not sure how editing works, check out how to edit a page, or use the sandbox to try out your editing skills. New contributors are always welcome. You don't even need to log in (although there are many reasons why you might want to).. WhatamIdoing (talk) 18:58, 20 June 2013 (UTC)

Limit of Viability: Math problem?

I think there is a mixup between gestational age and time since fertilization in the "Limit of Viability" section. Regarding the two youngest children to survive premature birth, it says: "Both children were born just under 22 weeks from fertilization, or a few days past the midpoint of an average full-term pregnancy, which equates to 24 weeks of a natural conception."

Yet, the paragraph directly above suggests that 24 weeks (for natural conception) corresponds to the 50% threshold for survival, thus suggesting that it is not at all unusual for children to survive birth at 24 weeks. Reading the cited sources, I think that there is a mixup between "gestational age" and "time since fertilization" and that the 22 weeks corresponds to the children's gestational age, not the time since fertilization (which would be ~ 20 weeks). I am taking out the "which equates ..." sentence, which I think is erroneous. — Preceding unsigned comment added by 206.49.107.56 (talk) 16:34, 5 December 2013 (UTC)

Is this information accurate?

I am a third year medical student who recently completed a rotation at a Yale University affiliated hospital, and the standard was to provide NICU care at 22 weeks 0 days. It seems the 24 weeks regularly being mentioned in this article is dated? — Preceding unsigned comment added by 76.118.188.160 (talk) 18:48, 8 February 2014 (UTC)

BAIPA Section

I added a section here about the Born-Alive Infants Protection Act of 2002. I specified that its implications for "viability" are not fully explored. This is still helpful, though, because it provides one place in law where a definition is provided for personal human life. -SocraticOath (talk) 16:10, 8 October 2015 (UTC)

External links modified

Hello fellow Wikipedians,

I have just modified one external link on Fetal viability. Please take a moment to review my edit. If you have any questions, or need the bot to ignore the links, or the page altogether, please visit this simple FaQ for additional information. I made the following changes:

• Added archive https://web.archive.org/web/20071209065838/http://www.canada.com:80/topics/bodyandhealth/story.html?id=db8f33ab-33e9-429f-bedc-b6ca80f61bdc to http://www.canada.com/topics/bodyandhealth/story.html?id=db8f33ab-33e9-429f-bedc-b6ca80f61bdc

When you have finished reviewing my changes, you may follow the instructions on the template below to fix any issues with the URLs.

This message was posted before February 2018. After February 2018, "External links modified" talk page sections are no longer generated or monitored by InternetArchiveBot. No special action is required regarding these talk page notices, other than regular verification using the archive tool instructions below. Editors have permission to delete these "External links modified" talk page sections if they want to de-clutter talk pages, but see the RfC before doing mass systematic removals. This message is updated dynamically through the template {{source check}} (last update: 5 June 2024).

• If you have discovered URLs which were erroneously considered dead by the bot, you can report them with this tool.
• If you found an error with any archives or the URLs themselves, you can fix them with this tool.

Cheers.—InternetArchiveBot (Report bug) 06:02, 31 December 2016 (UTC)

External links modified

Hello fellow Wikipedians,

I have just modified 2 external links on Fetal viability. Please take a moment to review my edit. If you have any questions, or need the bot to ignore the links, or the page altogether, please visit this simple FaQ for additional information. I made the following changes:

• Corrected formatting/usage for http://www.canada.com/topics/bodyandhealth/story.html?id=db8f33ab-33e9-429f-bedc-b6ca80f61bdc
• Added archive https://web.archive.org/web/20090326092358/http://www.baptisthealth.net/vgn/images/portal/cit_449/59/45/73662064factsheetTaylorbaby.pdf to http://www.baptisthealth.net/vgn/images/portal/cit_449/59/45/73662064factsheetTaylorbaby.pdf

When you have finished reviewing my changes, you may follow the instructions on the template below to fix any issues with the URLs.

This message was posted before February 2018. After February 2018, "External links modified" talk page sections are no longer generated or monitored by InternetArchiveBot. No special action is required regarding these talk page notices, other than regular verification using the archive tool instructions below. Editors have permission to delete these "External links modified" talk page sections if they want to de-clutter talk pages, but see the RfC before doing mass systematic removals. This message is updated dynamically through the template {{source check}} (last update: 5 June 2024).

• If you have discovered URLs which were erroneously considered dead by the bot, you can report them with this tool.
• If you found an error with any archives or the URLs themselves, you can fix them with this tool.

Cheers.—InternetArchiveBot (Report bug) 06:42, 30 September 2017 (UTC)

Very outdated sources

For some reason, a source from 1973 is being used to suggest that neonatologists in 2018 do not recessitate micro-preemies, very early preemies, or moderately early preemies. Maybe in the 70s this was true, but this is no longer the case. Trust me, I am a registered nurse practitioner specializing in cardiology and neonatology at a children's hospital. We have plenty of preemies who are under 500g in weight, and they generally do well. We certainly provide care for all of our patients no matter how small.72.141.197.112 (talk) 02:19, 5 July 2018 (UTC)

Limit of Viability

The article states that the limit of viability has not increased in the developed world since the early 90s. Untrue. A quick google turned up and article showing that is indeed has.

98.145.90.12 (talk) 00:34, 27 April 2019 (UTC)

References

Reversion of recent edits

A number of recent edits had issues. Let us take them in order:

" A fetus is generally considered viable at about 22 weeks of gestation, but the majority do not survive until around 24 weeks.[2] "

The source was the ACOG obstetric care consensus, which describes periviable birth. It doesn't actually classify viability as beginning at any specific gestational age. It also doesn't support the statement that the majority do not survive until around 24 weeks; it cites a number of studies with variable outcomes.

The image change I didn't mind a lot, but it was in a large block of edits and I couldn't fish it out. I'm not convinced it's a better image -- the first chart emphasizes the difference in outcomes between countries, and the new chart has one consistent block of data... and then one study from Japan reminding us that they still outperform the US by miles in this regard.

The "chance of survival" chart you edited to... some numbers without a source, as opposed to the old numbers that matched the source. Except, strangely, for the 22 and 23 week numbers.

" The limit of viability is the gestational age at which a prematurely born fetus/infant has a 50% chance of long-term survival outside its mother's womb. With the support of neonatal intensive care units, the limit of viability in the developed world has declined since "

You changed to

" The limit of viability is the gestational age at which a prematurely born fetus/infant has a 50% chance of long-term survival outside its mother's womb. With the support of neonatal intensive care units, an increased amount of premature infants survive compared to 50 years ago. "

This is both a grammatical and a substance error. It should be number, not amount, and it also doesn't communicate the concept. If more 32-34 week premies survived compared to 50 years ago, your statement would be true, but the limit of viability would not have changed.

You removed

"Another major factor is gender: male infants are slightly less mature and have a slightly higher risk of dying than female infants."

I promise it's true. I'll get a source.

So those are a lot of edits I disagree with, but I do agree with you that the article is outdated and needs some attention, and I applaud you for being bold. I look forward to cooperating with you on more constructive edits. I'll post proposed edits here in the coming week or so. Triacylglyceride (talk) 00:50, 18 June 2019 (UTC)

@Triacylglyceride: I don't really care much about all but two of those edits: the lead should include "A fetus is generally considered viable at about 22 weeks of gestation, but the majority do not survive until around 24 weeks," because there are numerous sources that cite that as correct. Around 5% of births after 22 weeks gestation are infants that survive, hence many sources cite that as the point of viability. 24 weeks is the point at which most newborns survive, so I don't see why you would dispute that either. Also, the sentence "The period of viability normally refers to the 24th week of gestation, when a human fetus is capable of living outside of the womb," is definitely more factually accurate than "The period of viability refers (traditionally) to the period after the twenty-eighth week,[18] or more recently the twenty-fourth week, of gestation when a human fetus is capable of living outside of the womb," since that is extremely outdated and hasn't been true for decades. The point of viability is most certainly 24 weeks at most, so 28 weeks is no where near accurate. Bill Williams (talk) 00:57, 18 June 2019 (UTC)

The source states that approximately 55% of newborns delivered after 22 weeks gestation survive, so how is it not accurate to say "the majority do not survive until around 24 weeks"? Bill Williams (talk) 01:01, 18 June 2019 (UTC)

Also, the current graph of preterm birth survival rates is very inaccurate. It makes it seem as if no newborns survive if they are born after 22 week gestation. That is incorrect, since around 5% of fetuses born after 22 weeks survive. Bill Williams (talk) 01:04, 18 June 2019 (UTC)

@LilBillWilliams: I agree with you that there are many outdated things. However, the idea of there being one point of viability is also outdated. I think that it's telling that the source you refer to (ACOG's care consensus document) refers to a broad range as "periviable," and doesn't identify any one point as being viable.

I think that this article should reflect that new, vaguer reality, and I'll take a crack at specific phrasing later this week.

I've reverted back your unsourced statement "A fetus is generally considered viable at about 22 weeks of gestation," which, like I said before, has no basis in the source cited. If you revert it back again, I will seek sanctions for edit warring.

I'll take the time to make sure there's a consensus on any edit that I make. I invite you to do the same. Triacylglyceride (talk) 04:37, 18 June 2019 (UTC)

How is a fetus not viable at 22 weeks if over 5% survive? That's a completely sources statement. If you want me to find a different source I can, because there are numerous sources saying that. Also. the sentence saying the 28th week is considered the point of viablility is completely outdated, so why are you keeping that sentence in the article? All it does it confuse people and make them think something incorrect. The point of viability hasn't been 28 weeks for decades. Bill Williams (talk) 11:33, 18 June 2019 (UTC)

New changes

I have reverted the changes by User:Kadysan, who is adding biased and misleading material. First of all, the survival rates which are relevant are those from all births at a specific gestational age (eg. 23 weeks), not the survival rates of those 23 weeks fetuses which are resuscitated. Of course the survival rates of resuscitated newborns are very good, because the doctors will not decide to resuscitate unless there is a good chance of survival. At 22 weeks for example, almost no doctor resuscitates (in many countries it's even illegal to resuscitate this early) so giving the survival rates of resuscitated 22 weeks is irrelevant and misleading. In this respect, this study, which User:Kadysan has repeatedly deleted, states:

"While there is no sharp limit of development, gestational age, or weight at which a human fetus automatically becomes viable,[1] a 2013 study found that "While only a small proportion of births occur before 24 completed weeks of gestation (about 1 per 1000), survival is rare and most of them are either fetal deaths or live births followed by a neonatal death." [13]"

User:Kadysan has deleted this repeatedly. The survival rates of resuscitated fetuses can be given, but they have to be put into context, and material relating to overall survival should not be deleted. Then, there is the misrepresentation of sources: what I think was the correct interpretation of a study: "Medical decisions regarding the resuscitation of extremely preterm infants (EPI) deemed to be in the "grey zone" usually take into account weight and gestational age, as well as parental views.[16][17][18][19] One 2018 study showed that there was a significant difference between countries in what was considered to be the "grey zone": the "grey zone" was considered to be 22.0 - 22.6/23 weeks in Sweden, 23.0 – 23.6/24 weeks in the UK, and 24.0-25.6/26 weeks in Netherlands.[16]" was changed by User:Kadysan to: "One study showed that in Sweden, neonatologists generally consider giving medical treatment to babies born at 22 weeks". They do not "generally" consider resuscitating any 22 weeks fetuses, only in certain situations (related to the presentation of the fetus and parental desires).

The table added by User:Kadysan states in regard to fetuses of 21 weeks: "Most physicians do not treat this age group, although there are reports of infants surviving at 21 weeks 4 days or later". Apart from the fact that "most" is a sort of understatement because in fact almost no physician ever does this and in most places it is actually illegal, the claims of the 21 weeks 4 days survival are to unreliable sources (2 media articles) and one source says that the birth was "21 weeks and six days after conception.", whereas the table is presumed to use the time elapsing from the last menstrual period, as this is the most common medical measurement of pregnancy.

I have restored the article to the original form. Given the controversial nature of it, major changes should be made only after WP:CONSENSUS.2A02:2F01:58FF:FFFF:0:0:6465:40E7 (talk) 05:13, 2 March 2020 (UTC)

Hi, this is Kadysan. I'm new to Wikipedia (hello!) and wanted to address my proposed changes. In terms of reaching consensus, I would say points 1, 8, and 12 in the Talk section about the outdated information and the U.S. centrism are addressed by my changes.

And I am happy to give a range of survival rates. The German study, which has the highest survival rates, gave only comfort care to babies whose parents requested it, but active care to babies whose parents chose that option; doctors were not the decision makers. And there were no significant differences in birth weight or with whether the babies were parts of multiples or not for those babies receiving comfort care or active care. So I don't think that these numbers are gross misrepresentations of what happens when 22 week babies are given active care.

From the same German study, they write "A recent report on ethics in delivery-room care emphasized the impact of self-fulfilling prophecies, meaning that the recommendation not to treat at 22 weeks of gestation inevitably has to lead to low rates of survival. Consequently, reports on big national cohorts in settings where treatment is predominantly withheld for extremely immature infants cannot produce valid data on survival." So we may have a grim view of survival rates because doctors don't treat.

For the "grey zone" study, consider here means consider the factors before deciding on whether to give treatment. I can clarify.

I can delete the part about 21 weeks if the sources aren't trusted. Would the Daily Mail be trusted? https://www.dailymail.co.uk/health/article-6497947/Smallest-preemie-baby-survivor-Lyla-Stensrud-born-21-weeks-one-pound-look-now.html — Preceding unsigned comment added by Kadysan (talk • contribs) 20:26, 5 March 2020 (UTC)

Removing and rewriting section.

The section:

Medical viability is generally considered to be between 23 and 24 weeks gestational age, meaning that these newborns have a < 50% chance of either dying or surviving with severe impairment if active care is instituted; this applies to most fetuses at ≥ 24 weeks of gestation, and to some fetuses at 23 weeks of gestation with favourable risk factors.

This section mostly pertains to the US rather and a worldwide perspective. Some of the sources linked are also news articles rather than scholarly work. SKAG123 (talk) 17:06, 24 September 2024 (UTC)

@SKAG123, I think that it would be great to update the article to provide more information about what's technologically possible with the most advanced care vs what's realistically available to the typical person globally (who probably lives in China or India and has a household income of perhaps US$1,000 per month). Can you find any good sources? WhatamIdoing (talk) 00:46, 26 September 2024 (UTC)

Personally I would remove that paragraph and just leave it at “fetal viability can defer based on country and technology available” or something similar. It’s the introduction so we don’t need to get into the details. SKAG123 (talk) 03:32, 26 September 2024 (UTC)

I think it would be better to highlight the developed/developing divide. Maybe something like "With the most advanced medical care, about half of babies born between 23 and 24 weeks gestational age will survive, but in most of the world, advanced medical technology is unavailable, and most babies will die if they are born before ___ weeks"? WhatamIdoing (talk) 04:17, 26 September 2024 (UTC)

Sure that looks good SKAG123 (talk) 19:42, 30 September 2024 (UTC)

Do you have any idea what number should be in the ____? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8304356/ says that in the 1960s, it was 28 weeks in the US, but I think that was probably a "record-setting survival" rather than a median survival. Patrick Bouvier Kennedy was born at 34.5 weeks, with the best medical care in 1963, and still died. WhatamIdoing (talk) 05:36, 1 October 2024 (UTC)