Lethal fetal abnormalities: how to approach perinatal palliative care?

J Matern Fetal Neonatal Med. 2017 Mar;30(6):755-758. doi: 10.1080/14767058.2016.1186633. Epub 2016 May 26.

Abstract

Objective: Some of the antenatally diagnosed fetal pathologies are unlikely to get compatible with life. Still some women choose to continue with pregnancy. Subsequently, perinatal palliative care (PPC) has become a constructive demarche in such situations. Our study, based on a multicentric survey, reports some cases of fetal pathologies considered as lethal according to perinatal professionals and reveals the decisional process in each case.

Methods: We sent by emails a questionnaire to 434 maternal-fetal medicine specialists and fetal care pediatric specialists at 48 multidisciplinary centers for prenatal diagnosis.

Results: The participation rate was 49.3%. In total, 61 obstetric-gynecologists and 68 neonatologists completed the survey. The results showed that 35.4% of the pregnant women asked for the continuation of pregnancy and 24.7% asked for the termination of pregnancy. More than half of professionals (52.9%) took the initiative of informing women about the options for birth support (including PPC), while 32.7% of obstetric gynecologists did not take this initiative versus 10.2% of neonatologists (p < 0.01).

Conclusion: This study demonstrates the absolute need to provide PPC training for professionals and to standardize its practices.

Keywords: Ethical issue; fetal abnormality; information; palliative care; perinatal medicine.

Publication types

  • Multicenter Study

MeSH terms

  • Attitude of Health Personnel*
  • Female
  • Fetus / abnormalities*
  • Humans
  • Infant, Newborn
  • Palliative Care / organization & administration*
  • Palliative Care / psychology
  • Parents / psychology*
  • Perinatal Care / organization & administration*
  • Physician-Patient Relations
  • Pregnancy
  • Prenatal Diagnosis
  • Surveys and Questionnaires