Decision on level of intervention

An open discussion with prospective parents regarding potential outcomes and the likelihood of severe handicap is a vital part of management of extreme threatened PTL. Proactive management in­cluding tocolysis to allow transfer to a facility with level 1 neonatal care, the use of antenatal steroids, and prompt neonatal resuscita­tion will increase the likelihood of survival. Ultrasound estimation of fetal weight may help guide management as mortality rates for infants weighing between 400 and 500 g is 83% (75).