Management of patients at high risk of extreme premature birth between 23 and 26 weeks should be performed by an experienced multidisciplinary team. In order to optimize guidance for couples with regard to this complex decision, we developed joint guidelines between obstetricians and neonatologists, in order to standardize practices and insure individualized care plans. Fetal outcome is not solely associated with gestational age but is multifactorial, and this should be considered when counseling parents. Thus, enhancement of fetal lung maturation, a major prognostic factor, should be promptly acted upon when delivery is anticipated. Antenatal corticosteroids should not be withheld while awaiting the parents' ultimate decision on neonatal care.