On the occasion of the World prematurity day (celebrated on 17th November) I had posted a simple looking question for all my doctor friends. The question was ” Fill in  the blanks”. It said :” Premature birth is a birth from ___ weeks to 37 weeks of pregnancy.” As expected I got the answers ranging from 20 weeks to 30 weeks!

The true answer is ” NOK … No one knows”! Surprised and stunned! Yes I am right. There is no legal clarity on the subject in India. If we see the progression of intrauterine life … this is how it goes.
6-7 weeks: we can see the presence of life in form of beating heart on USG.
20 weeks: limit for termination of pregnancy.
24 to 28 weeks: Some where around this time the fetus becomes ” viable”… means “capable of independent survival”. Before this time the fetus is not considered to survive even after medical help. Thus technically it is the “viability” which makes one change the nomenclature from “miscarriage to preterm birth.” Thus the process of expulsion of fetus from the womb when happens before the age of viability is miscarriage and after it is birth.
Now let me come back to my original fill in the blanks. The answer to the question varies from country to country and depends upon the quality of premature baby care available. WHO and UK consider viability age as 24 weeks. In India very few centers such as Cloudnine group of hospitals and few others may be able to send the baby home intact at 24 weeks. Practically it will be 26 to 28 weeks in most of the Indian hospitals.
One may ask why am I discussing all this? How does it matter in our life? The truth is we may be wrongly portraying our health care parameters in bad light due to this.
Due of lack of clarity most doctors prefer to call it as “preterm birth ” after 20 weeks.
Effect: we are unnecessarily calling “miscarriages” as “births”. Thus we are wrongly reporting the data. Thus we are wrongly showcasing high neonatal mortality statistics. Neonatal mortality is a quality indicator of health care according to WHO. And we score very low on it … courtesy lack of clarity.

It is the time that Government clarifies the exact limit of viability in our country and answer the “fill in the gap” authoritatively. Is Government going to solve this problem? Are medical organizations such as IMA, FOGSI, IAP listening and interested?