Live birth (human)

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In human reproduction, a live birth occurs when a fetus exits the mother showing any definite sign of life such as voluntary movement, heartbeat, or pulsation of the umbilical cord, for however brief a time and regardless of whether the umbilical cord or placenta are intact. [1] After the fetus is expelled from the maternal body it is called a neonate. Whether the birth is vaginal or by caesarean section, and whether the neonate is ultimately viable, is irrelevant.

Contents

The definition of the term "live birth" was created by the World Health Organization in 1950, and is chiefly used for public health and statistical purposes. However, the term "live birth" was in common use long before 1950. [2]

In the United States, the term "born alive" is defined by federal law [3] known as the born alive rule. Live births are recorded on a U.S. Standard Certificate of Live Birth, also known as a birth certificate. [4] The United States recorded 3,605,201 live births in 2020 which is a 4% decrease from 2019 and the 6th consecutive year of decline in births. [5]

Not all pregnancies result in live births. A woman may choose to end her pregnancy by abortion. Miscarriage, also known as spontaneous abortion and pregnancy loss, is the natural death of an embryo or fetus before it is able to survive independently. [6] [7] Some use the cutoff of 20 weeks of gestation, after which fetal death is known as a stillbirth. [8] The death of the fetus or neonate at the end of the pregnancy, during labour and delivery, or just after birth is counted as perinatal mortality.

Statistical significance

Factors affecting viability

Gestational age

Measured in weeks, gestational age is a term used to describe how far along a pregnancy is starting from the first day of the woman's last menstrual cycle to the current date. [9] A baby born "at term" is between the gestational age of 37 weeks to 41 weeks. A preterm baby is born before the gestational age of 37 weeks. A pregnancy that lasts 41 weeks up to 42 weeks is called late-term and a pregnancy longer than 42 weeks is called post-term. [10] The general consensus is that a fetus is viable at 24 weeks, however, a live birth may occur earlier in gestation with the assistance from neonatal intensive care unit (NICU) resources. Gestational age is the main determinant of whether a baby will be able to live and survive outside of the uterus.

Other factors

While gestational age is the most significant predictor of fetal viability, the condition of the neonate at birth also significantly indicates how well it tolerates life outside of the mother. Factors measured at birth include birth weight, head circumference, and body length. An Apgar score is given at the time of birth to report the status of the newborn infant and the response to resuscitation if needed. [11]

Recovery

The maternal recovery period directly following the events of human childbirth, regardless of whether it is a live birth, is called the postpartum period.

Special cases

There is one case report of a woman having a live birth derived from a frozen embryo obtained before she began cancer treatment. [12]

See also

Related Research Articles

<span class="mw-page-title-main">Multiple birth</span> Delivery of two or more offspring during childbirth

A multiple birth is the culmination of one multiple pregnancy, wherein the mother gives birth to two or more babies. A term most applicable to vertebrate species, multiple births occur in most kinds of mammals, with varying frequencies. Such births are often named according to the number of offspring, as in twins and triplets. In non-humans, the whole group may also be referred to as a litter, and multiple births may be more common than single births. Multiple births in humans are the exception and can be exceptionally rare in the largest mammals.

<span class="mw-page-title-main">Miscarriage</span> Natural death and expulsion of an embryo or fetus before its independent survival

Miscarriage, also known in medical terms as a spontaneous abortion, is the death and expulsion of an embryo or fetus before it is able to survive independently. The term miscarriage is sometimes used to refer to all forms of pregnancy loss and pregnancy with abortive outcome before 20 weeks of gestation.

<span class="mw-page-title-main">Stillbirth</span> Death of a fetus before or during delivery, resulting in delivery of a dead baby

Stillbirth is typically defined as fetal death at or after 20 or 28 weeks of pregnancy, depending on the source. It results in a baby born without signs of life. A stillbirth can often result in the feeling of guilt or grief in the mother. The term is in contrast to miscarriage, which is an early pregnancy loss, and Sudden Infant Death Syndrome, where the baby dies a short time after being born alive.

<span class="mw-page-title-main">Umbilical cord</span> Conduit between embryo/fetus and the placenta

In placental mammals, the umbilical cord is a conduit between the developing embryo or fetus and the placenta. During prenatal development, the umbilical cord is physiologically and genetically part of the fetus and normally contains two arteries and one vein, buried within Wharton's jelly. The umbilical vein supplies the fetus with oxygenated, nutrient-rich blood from the placenta. Conversely, the fetal heart pumps low-oxygen, nutrient-depleted blood through the umbilical arteries back to the placenta.

Late termination of pregnancy, also referred to as third trimester abortion, describes the termination of pregnancy by induced abortion during a late stage of gestation. In this context, late is not precisely defined, and different medical publications use varying gestational age thresholds. As of 2015 in the United States, more than 90% of abortions occur before the 13th week, 1.3% of abortions in the United States took place after the 21st week, and less than 1% occur after 24 weeks.

<span class="mw-page-title-main">Cardiotocography</span> Technical means of recording the fetal heartbeat and the uterine contractions during pregnancy

Cardiotocography (CTG) is a technique used to monitor the fetal heartbeat and uterine contractions during pregnancy and labour. The machine used to perform the monitoring is called a cardiotocograph.

Fetal viability is the ability of a human fetus to survive outside the uterus. Medical viability is generally considered to be between 23 and 24 weeks gestational age. Viability depends upon factors such as birth weight, gestational age, and the availability of advanced medical care. In low-income countries, half of newborns born at or below 32 weeks gestational age died due to a lack of medical access; in high-income countries, the vast majority of newborns born above 24 weeks gestational age survive.

In obstetrics, gestational age is a measure of the age of a pregnancy taken from the beginning of the woman's last menstrual period (LMP), or the corresponding age of the gestation as estimated by a more accurate method, if available. Such methods include adding 14 days to a known duration since fertilization, or by obstetric ultrasonography. The popularity of using this measure of pregnancy is largely due to convenience: menstruation is usually noticed, while there is generally no convenient way to discern when fertilization or implantation occurred.

<span class="mw-page-title-main">Pregnancy</span> Time of offspring development in mothers body

Pregnancy is the time during which one or more offspring develops (gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins.

Prenatal development includes the development of the embryo and of the fetus during a viviparous animal's gestation. Prenatal development starts with fertilization, in the germinal stage of embryonic development, and continues in fetal development until birth.

<span class="mw-page-title-main">Prelabor rupture of membranes</span> Medical condition

Prelabor rupture of membranes (PROM), previously known as premature rupture of membranes, is breakage of the amniotic sac before the onset of labor. Women usually experience a painless gush or a steady leakage of fluid from the vagina. Complications in the baby may include premature birth, cord compression, and infection. Complications in the mother may include placental abruption and postpartum endometritis.

<span class="mw-page-title-main">Complications of pregnancy</span> Medical condition

Complications of pregnancy are health problems that are related to, or arise during pregnancy. Complications that occur primarily during childbirth are termed obstetric labor complications, and problems that occur primarily after childbirth are termed puerperal disorders. While some complications improve or are fully resolved after pregnancy, some may lead to lasting effects, morbidity, or in the most severe cases, maternal or fetal mortality.

Postterm pregnancy is when a woman has not yet delivered her baby after 42 weeks of gestation, two weeks beyond the typical 40-week duration of pregnancy. Postmature births carry risks for both the mother and the baby, including fetal malnutrition, meconium aspiration syndrome, and stillbirths. After the 42nd week of gestation, the placenta, which supplies the baby with nutrients and oxygen from the mother, starts aging and will eventually fail. Postterm pregnancy is a reason to induce labor.

<span class="mw-page-title-main">Perinatal mortality</span> Medical condition

Perinatal mortality (PNM) is the death of a fetus or neonate and is the basis to calculate the perinatal mortality rate. Perinatal means "relating to the period starting a few weeks before birth and including the birth and a few weeks after birth."

A fetus or foetus is the unborn offspring that develops from an animal embryo. Following embryonic development the fetal stage of development takes place. In human prenatal development, fetal development begins from the ninth week after fertilization and continues until birth. Prenatal development is a continuum, with no clear defining feature distinguishing an embryo from a fetus. However, a fetus is characterized by the presence of all the major body organs, though they will not yet be fully developed and functional and some not yet situated in their final anatomical location.

<span class="mw-page-title-main">Fetal membranes</span> Amnion and chorion which surround and protect a developing fetus

The fetal membranes are the four extraembryonic membranes, associated with the developing embryo, and fetus in humans and other mammals. They are the amnion, chorion, allantois, and yolk sac. The amnion and the chorion are the chorioamniotic membranes that make up the amniotic sac which surrounds and protects the embryo. The fetal membranes are four of six accessory organs developed by the conceptus that are not part of the embryo itself, the other two are the placenta, and the umbilical cord.

<span class="mw-page-title-main">Circumvallate placenta</span> Medical condition

Circumvallate placenta is a rare condition affecting about 1-2% of pregnancies, in which the amnion and chorion fetal membranes essentially "double back" on the fetal side around the edges of the placenta. After delivery, a circumvallate placenta has a thick ring of membranes on its fetal surface. Circumvallate placenta is a placental morphological abnormality associated with increased fetal morbidity and mortality due to the restricted availability of nutrients and oxygen to the developing fetus.

<span class="mw-page-title-main">High-risk pregnancy</span> Medical condition

A high-risk pregnancy is one where the mother or the fetus has an increased risk of adverse outcomes compared to uncomplicated pregnancies. No concrete guidelines currently exist for distinguishing “high-risk” pregnancies from “low-risk” pregnancies; however, there are certain studied conditions that have been shown to put the mother or fetus at a higher risk of poor outcomes. These conditions can be classified into three main categories: health problems in the mother that occur before she becomes pregnant, health problems in the mother that occur during pregnancy, and certain health conditions with the fetus.

Definitions of abortion vary from one source to another. Abortion has many definitions that can differ from each other in significant ways. Given the contentious nature of abortion, lawmakers and other stakeholders often face controversy in defining abortion. Language referring to abortion often reflects societal and political opinions . Influential non-state actors like the United Nations and the Roman Catholic Church have also engendered controversy over efforts to define abortion.

Early pregnancy bleeding refers to vaginal bleeding before 14 weeks of gestational age. If the bleeding is significant, hemorrhagic shock may occur. Concern for shock is increased in those who have loss of consciousness, chest pain, shortness of breath, or shoulder pain.

References

  1. World Health Organization. International statistical classification of diseases and related health problems. Tenth Revision. Vol 2. Geneva, Switzerland: World Health Organization, 1993:129.
  2. Search full view Google Books for "live birth" prior to the year 1950.
  3. "1 U.S. Code § 8 - "Person", "human being", "child", and "individual" as including born-alive infant". LII / Legal Information Institute. Retrieved 22 August 2017.
  4. "NVSS - Revisions of the U.S. Standard Certificates and Reports". www.cdc.gov. 2017-08-30. Retrieved 2018-10-23.
  5. Hamilton, Brady; Martin, Joyce; Osterman, Michelle (May 2021). "Births: Provisional Data for 2020" (PDF). Division of Vital Statistics, National Center for Health Statistics. Vital Statistics Rapid Release. National Vital Statistics System. Report No. 012 via CDC.
  6. The Johns Hopkins Manual of Gynecology and Obstetrics (4 ed.). Lippincott Williams & Wilkins. 2012. pp. 438–439. ISBN   9781451148015. Archived from the original on September 10, 2017.
  7. "What is pregnancy loss/miscarriage?". www.nichd.nih.gov/. July 15, 2013. Archived from the original on April 2, 2015. Retrieved March 14, 2015.
  8. "Stillbirth: Overview". NICHD. September 23, 2014. Archived from the original on October 5, 2016. Retrieved October 4, 2016.
  9. "Gestational age: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 2022-06-23.
  10. "When Pregnancy Goes Past Your Due Date". www.acog.org. Retrieved 2022-06-23.
  11. "The Apgar Score". www.acog.org. Retrieved 2022-06-25.
  12. Yang, Dunsong; Brown, Samuel E.; Nguyen, Kevin; Reddy, Vijay; Brubaker, Cindy; Winslow, Kevin L. (1 June 2007). "Live birth after the transfer of human embryos developed from cryopreserved oocytes harvested before cancer treatment". Fertility and Sterility. 87 (6): 1469.e1–4. doi:10.1016/j.fertnstert.2006.07.1546. PMID   17418837.