More ‘miscarriages’ to be deemed stillbirths as survival rates for babies born at 23 weeks rise

The previous clinical recommendation was that the threshold for foetal viability was 24-weeks’ gestation. Photo: Getty Images© Getty Images

Eilish O'Regan

The increasing chances of survival for babies born at 23 weeks in pregnancy will lead to a change in the definition of stillbirth, it has emerged.

Currently, a stillbirth is defined as when a baby is delivered after 24 weeks or more of pregnancy and is not alive.

This was based on a previous clinical recommendation that the threshold for foetal viability was 24 weeks’ gestation.

A pregnancy loss at 23 weeks of pregnancy is currently deemed a miscarriage.

Health Minister Stephen Donnelly said following a new assessment the threshold of foetal viability should be reduced from 24 to 23 weeks’ gestation.

This will have implications for the definition of stillbirth which affects around 300 babies annually.

It will also mean more parents who experience stillbirth will have their child recognised, and will be supported around parental leave, funeral requirements and access to bereavement care.

He said: “I am advised that in response to ongoing clinical advances in neonatal care, both nationally and internationally, the survival of premature infants born at 23 weeks’ gestation has improved.

“Increasingly, infants born at 23 weeks’ gestation are being offered resuscitation and neonatal intensive care. This is the experience both in Ireland and in other developed countries.

“In that context, the HSE and the Royal College of Physicians in Ireland have produced a framework document in relation to the management of extreme pre-term birth. The framework document recommends that the threshold of foetal viability should be reduced from 24 weeks’ gestation to 23 weeks’ gestation.

“It replaces the previous consensus document from 2006 which stated that the threshold of foetal viability was 24 weeks’ gestation,” he said in a parliamentary response to TD Darren O’Rourke.

He said that, “arising from this clinically informed reduction in the threshold of viability, and following engagement between my officials and the HSE, I accepted a recommendation that the definition of stillbirth, as used in the Civil Registration Act 2004, should be updated to reflect this lower threshold.

“As such, I am proposing to amend the definition of stillbirth to change the gestational age from 24 weeks to 23 weeks, along with a corresponding reduction in the existing weight criteria in the definition of stillbirth from 500 grammes to 400 grammes.

“The proposed amendment also includes an additional provision to enable the registration of children from multiple pregnancies, for example, twins and triplets, as stillborn in circumstances where they do not meet all of the clinical criteria of a stillborn child.

“My officials are engaging with the Department of Social Protection to progress these legislative changes to ensure that the definition of stillbirth aligns with current clinical practice.”

The Royal College of Physicians consensus document which recommended a change in the threshold of foetal viability from 24 to 23 weeks’ gestation said initiation of life-sustaining treatment is not recommended for infants born less than 23 weeks.

Previously a team in UCC along with the National Perinatal Epidemiology Centre recommended the threshold be reduced to 22 weeks.

It said other countries have proven that 22-week survival rates can be raised to as much as 30pc with active care measures. Rates are only likely to improve with medical advances.

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