Dr. Morgan is a board-certified Maternal-Fetal Medicine subspecialist and Assistant Professor at the University of Connecticut School of Medicine. She practices at a Fetal Care Center, where she counsels families facing periviable delivery and complex fetal diagnoses.
She serves on the SMFM Reproductive Health Committee.
"At periviable gestational ages, families are asked to make decisions no parent should have to make, on a timeline that feels impossible. What this guide offers is honesty about what the evidence shows and what it does not."
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Elizabeth Morgan MD · Periviable Preterm Birth Decision Aid
Questions to bring to your care team
Generated based on your gestational age and your responses. Bring this to your next appointment.
Support beyond the decision
Navigating a complex pregnancy is one of the most emotionally demanding experiences a person can go through. If you are struggling beyond the decision itself — with fear, grief, isolation, or weight that feels unmanageable — support is available.
Postpartum Support International:postpartum.net — helpline, provider directory, pregnancy and loss support
National Maternal Mental Health Hotline: 1-833-943-5746 — 24/7, free, confidential
You may be facing one of the hardest decisions a parent can face.
When a baby may be born between 22 and 26 weeks of pregnancy, families are asked to make decisions about resuscitation, intensive care, and goals of care under enormous time pressure, often without enough context to know what the options really mean.
This guide will not tell you what to decide. It will give you honest information about what the evidence shows at each gestational age, what your options involve, and a personalized list of questions to bring to your care team. This information is rapidly evolving and institution dependent, and very reliant on clinical situation; all survival estimates should be reviewed with a NICU provider and your obstetric team.
This takes about 10–15 minutes. At the end you will have a printable summary and a question list tailored to your situation. Nothing is stored or transmitted; everything stays on your device.
Not a substitute for clinical care. Outcome data from NICHD NRN 2018–2022.
Step 1 of 4 · Gestational Age
What is your gestational age?
Outcomes at periviable gestational ages change meaningfully week by week. Select your gestational age to see population-level outcome data. Population-level estimates mean these numbers represent averages across many centers; your center's outcomes may differ.
What this means
These numbers come from national data collected across many hospitals. High-volume centers; like academic fetal care centers; tend to have better outcomes than the national average. Always ask your specific center for their own numbers.
All data: NICHD Neonatal Research Network 2018–2022; ACOG/SMFM Obstetric Care Consensus No. 3.
Survival with active resuscitation
Active resuscitation
Intervening at birth to support the baby's breathing and circulation; including intubation, ventilator support, and NICU admission. The full range of medical intervention to give the baby the best chance of survival.
Intact survival
Intact survival
Survival without major neurodevelopmental impairment; the outcome most families mean when they ask "will my baby be okay?" It is a meaningful distinction from survival alone.
These are rates among infants who survive with active care; not rates for all births at this gestational age.
Severe IVH, severe BPD, and NEC are the most serious complications. Neurodevelopmental impairment is the outcome families most often ask about in the long term.
Severe IVH; Intraventricular Hemorrhage (grades 3–4)
Bleeding into or around the fluid-filled spaces of the brain. Grades 3–4 are the most serious and are associated with higher risk of long-term neurological differences. Not all IVH leads to significant impairment, but severe IVH is a meaningful risk factor.
Severe BPD; Bronchopulmonary Dysplasia
Also called chronic lung disease of prematurity. Caused by the need for prolonged mechanical ventilation and oxygen in immature lungs. Can require respiratory support for months to years after discharge from the NICU.
NEC; Necrotizing Enterocolitis
A serious intestinal complication in premature infants in which intestinal tissue becomes inflamed and can die. Severe cases require surgery. It is one of the most feared complications of extreme prematurity.
Neurodevelopmental impairment
Differences in cognitive, motor, language, or social development identified in the months and years after NICU discharge. The spectrum is wide; from mild learning differences to significant cognitive or physical disability. Not all survivors have impairment, and outcomes are not fully predictable in the NICU.
Mode of delivery
Why this matters: Many families don't realize that the decision about how to deliver has implications for the pregnant person's future pregnancies. A classical uterine incision carries risks that a standard low transverse incision does not.
Classical (vertical) uterine incision
At very early gestational ages, a standard low transverse cesarean incision is often not possible because the lower uterine segment is not yet developed. A classical incision; vertical through the main body of the uterus; is more likely. This incision carries a higher risk of uterine rupture in future pregnancies and typically requires cesarean delivery for all subsequent pregnancies.
How are you feeling emotionally right now as you work through this?
Select a gestational age to continue.
Step 2 of 4 · Your Options
Paths that are available to you
Select any options you want to explore; you can select more than one. Expand any card to see what it involves, what to weigh, and a note from Dr. Morgan. All options are presented without judgment.
Step 3 of 4 · What Matters
Clarifying what feels most true
These questions have no right answers. They help shape the question list you receive in the next step. Nothing is stored or transmitted.
Step 4 of 4 · Your Questions
Questions to bring to your care team
Generated based on your gestational age and your answers. These are starting points; add your own below.
A note on goals of care
Whatever direction you are leaning, a documented goals-of-care plan before delivery is important. Ask your team to put it in writing and make sure everyone involved in your care has seen it.
Goals of care
A structured conversation between families and the medical team that documents the family's wishes, values, and decisions about intervention. A goals-of-care plan created before delivery helps ensure those wishes are honored in the delivery room, when there may not be time for discussion.
Reference
Terms used in this guide
Tap any highlighted term in the guide to see its definition inline. All definitions are also listed here.
Active resuscitation
Intervening at birth to support the baby's breathing and circulation; including intubation, ventilator support, and NICU admission. The full range of medical intervention to give the baby the best chance of survival.
Intact survival
Survival without major neurodevelopmental impairment. This is the outcome most families mean when they ask "will my baby be okay?" It is a meaningful distinction from survival alone.
Severe IVH (Intraventricular Hemorrhage, grades 3-4)
Bleeding into or around the fluid-filled spaces of the brain. Grades 3-4 are the most serious and are associated with higher risk of long-term neurological differences. Not all IVH leads to significant impairment, but severe IVH is a meaningful risk factor.
Severe BPD (Bronchopulmonary Dysplasia)
Also called chronic lung disease of prematurity. Caused by the need for prolonged mechanical ventilation and oxygen in immature lungs. Can require respiratory support for months to years after NICU discharge.
NEC (Necrotizing Enterocolitis)
A serious intestinal complication in premature infants in which intestinal tissue becomes inflamed and can die. Severe cases require surgery. One of the most feared complications of extreme prematurity.
Neurodevelopmental impairment
Differences in cognitive, motor, language, or social development identified in the months and years after NICU discharge. The spectrum is wide; from mild learning differences to significant cognitive or physical disability. Not all survivors have impairment, and outcomes are not fully predictable in the NICU.
Classical (vertical) uterine incision
A vertical incision through the main body of the uterus. At very early gestational ages this may be necessary because the lower uterine segment is not yet developed. This incision carries a higher risk of uterine rupture in future pregnancies and typically requires cesarean delivery for all subsequent pregnancies.
Goals of care
A structured conversation between families and the medical team that documents the family's wishes, values, and decisions about intervention. A goals-of-care plan created before delivery helps ensure those wishes are honored in the delivery room, when there may not be time for discussion.
Population-level estimates
Numbers that represent averages across many hospitals and many patients. High-volume centers tend to have better outcomes than the national average. This information is rapidly evolving and institution dependent; always ask your specific center for their own data.
Your own questions
What else do you need to know? These will appear on your printed list.
Have more questions?
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