Before we begin
What does "periviable" mean?
A plain-language explanation of this gestational age window and what it means for your family.
Periviable means "around the edge of survival." Pregnancies between 22 and 25 weeks are in a unique zone where some babies survive with intensive care and some do not. This range is different from later preterm births — the outcomes here are less certain, and they vary widely from hospital to hospital.
At this gestational age, even a few days can make a meaningful difference in your baby's lungs, brain development, and overall readiness for the world outside the womb. The specific week — and even the day — of your pregnancy matters when talking with your care team.
If your baby is born in this window and active resuscitation is chosen, they will likely go to a neonatal intensive care unit (NICU). This means breathing support, IV nutrition, close monitoring, and a hospital stay that may last weeks to months — until close to the original due date.
ACOG, SMFM, and the AAP recognize that decisions about care at this gestational age belong to families — in close partnership with their medical team. There is no single right answer. Your values, your baby's specific circumstances, and the resources at your hospital all matter.
Outcome data
Outcomes by gestational age
Select your gestational age to see national outcome data. Ranges reflect the real variation between hospitals in the United States — this is intentional. Showing a single number would create false certainty that does not exist.
At 22 weeks, the lungs are in very early development and the brain is not yet fully formed. Survival is possible at some hospitals, but it is not the most common outcome. Many hospitals approach 22 weeks differently — some offer full resuscitation, others offer comfort-focused care as the primary option. The variation in survival between hospitals is wider at 22 weeks than at any other gestational age.
ACOG and SMFM recommend that families at 22 weeks be offered honest information and be supported in whichever approach aligns with their values — including choosing comfort-focused care for their baby.
At 23 weeks, survival is possible at most hospitals that offer active resuscitation, but it is not guaranteed. The range of outcomes between hospitals remains wide — outcomes depend significantly on the experience of the NICU team, whether steroids were given, your baby's sex, and other factors. Most families who receive intensive care for a 23-week baby will face a long NICU stay with serious medical challenges along the way.
ACOG and SMFM recognize 23 weeks as within the zone of parental discretion — meaning both active resuscitation and comfort-focused care are ethically and medically appropriate choices, depending on a family's values and situation.
At 24 weeks, the majority of hospitals in the United States will offer active resuscitation. Survival rates are meaningfully higher than at 22–23 weeks, though serious complications remain common. A significant portion of babies born at 24 weeks will survive to go home, though many will face an extended NICU stay and ongoing medical needs.
ACOG and SMFM consider 24 weeks to be at the upper end of the shared decision-making zone. Most clinical teams will recommend active resuscitation at this gestational age, though the specific conversation still belongs to the family and their care team.
At 25 weeks, the majority of babies born at hospitals equipped to care for very premature infants will survive to go home. This does not mean the NICU course is easy — most 25-week babies will still face weeks to months of hospital care, and many will have ongoing medical needs after discharge. But the trajectory here is meaningfully more encouraging than at 22–24 weeks.
At 25 weeks, active resuscitation is recommended by ACOG, SMFM, and the AAP as the standard approach. Comfort-focused care is still a conversation that families can initiate, and the medical team will honor that discussion.
Individual factors
Factors that may shift the outlook
These factors are known to influence outcomes at periviable gestational ages. Check any that apply to your situation.
Important context
What these numbers don't tell you
Outcome statistics are a starting point — not the whole story.
Shared decision-making
Questions to explore with your family and care team
NICU glossary
Terms you will hear in the first 48 hours
Plain-language definitions for the medical words your care team will use. This is not a complete medical glossary — it is a starting point for the conversations ahead.
Bleeding inside the fluid-filled chambers of the brain. It is graded from I (mild) to IV (most severe). Grade I–II bleeds often resolve without serious effects. Grade III–IV bleeds can affect a child's brain development and long-term function. A brain ultrasound in the first few days of life is the standard way to check for this.
Injury or softening of the white matter of the brain near the ventricles. This is a form of brain injury that is associated with problems with movement (including cerebral palsy), learning, and vision. It is seen on brain ultrasound, sometimes not until several weeks after birth.
A serious intestinal condition in premature babies where part of the bowel becomes inflamed and may die. It can range from mild (treated with antibiotics and stopping feeds temporarily) to severe (requiring surgery to remove part of the intestine). NEC is one of the more feared NICU complications and is more common in very premature babies.
Chronic lung disease that develops in very premature babies who needed long-term breathing support. Babies with BPD may still need oxygen after leaving the hospital. Most improve significantly over the first 1–2 years of life as the lungs continue to grow and develop.
Abnormal blood vessel growth in the retina (the back of the eye) that can develop in premature babies. Mild ROP often resolves on its own. Severe ROP can affect vision and may require laser treatment. Eye exams are a routine part of NICU care for very premature babies.
A blood vessel near the heart that normally closes shortly after birth but often remains open in premature babies. A PDA can make the heart and lungs work harder. It may close on its own, be treated with medication, or rarely require a small procedure to close it.
A serious infection in the bloodstream. Premature babies are more vulnerable to infection because their immune systems are not yet fully developed. Signs of sepsis are often subtle in newborns — the NICU team watches closely and acts quickly when an infection is suspected.
Nutrition given directly into a vein when a baby cannot yet be fed through the stomach. TPN contains everything a premature baby needs — proteins, fats, sugars, vitamins, and minerals. It is used in the early days and weeks of life until the baby can tolerate breast milk or formula through a feeding tube.
A thin flexible tube placed into a large vein, used to give TPN, medications, and fluids. It stays in place for days to weeks so that the baby does not need a new IV line placed frequently.
Holding your baby on your bare chest, skin-to-skin. Research shows that kangaroo care improves temperature regulation, breathing stability, weight gain, and bonding — and it reduces parental stress. It can often begin earlier in the NICU stay than families expect. Ask your nurse when it might be possible for your baby.
Clinical reference
For clinicians
Guideline-level summary for counseling sessions. Expand to view.
The following summarizes the ACOG/SMFM/AAP periviability statement (2020) and NICHD NRN data (Rysavy 2015, Rysavy 2023) for use in direct patient counseling.
| GA | Survival (range) | Survival w/o major morbidity | ACOG/SMFM/AAP recommendation |
|---|---|---|---|
| 22 wks | 0–18% | 0–5% | Either active intervention or comfort-focused care is appropriate. Parental preference central. Document counseling thoroughly. |
| 23 wks | 15–55% | 5–18% | Zone of parental discretion. Both approaches ethically defensible. Offer full counseling including center-specific data if available. |
| 24 wks | 42–72% | 14–32% | Active resuscitation generally recommended. Comfort-focused care should still be discussed if family raises it. Antenatal steroids strongly indicated. |
| 25 wks | 66–88% | 28–48% | Active resuscitation is standard of care. Outcomes increasingly favorable. Steroids, MgSO4 for neuroprotection, and level III/IV center delivery recommended. |
Key interventions — document in counseling note
- Antenatal corticosteroids (betamethasone 12 mg IM × 2, 24 hrs apart): benefit demonstrated at 22–25 wks; administer if delivery anticipated within 7 days
- Magnesium sulfate for neuroprotection: recommended at <32 wks if delivery anticipated within 24 hrs (ACOG PB #455)
- GBS prophylaxis: per standard intrapartum protocol regardless of gestational age
- Neonatology consult: document that family met with neonatology team prior to delivery
- Ethics consultation: consider for cases with significant family-team disagreement or clinical uncertainty
Suggested counseling note documentation
Counseling was provided to [patient] and [support person] regarding periviable delivery at [GA]. National outcome data including survival ranges and morbidity estimates were reviewed. Prognostic modifiers discussed: [fetal sex, ACS status, plurality, growth]. The zone of parental discretion was explained. Patient/family expressed [preference for active resuscitation / preference for comfort-focused care / desire for additional time/information]. Neonatology was [consulted / plan to consult]. [Ethics was / was not] involved. Goals of care: [document]. Plan: [document].
Evidence base
Guideline references
All content is anchored to peer-reviewed guidelines and landmark clinical trials.