Prenatal parental involvement in decision for delivery room management at 22-26 weeks of gestation in France - The EPIPAGE-2 Cohort Study

PLoS One. 2019 Aug 29;14(8):e0221859. doi: 10.1371/journal.pone.0221859. eCollection 2019.

Abstract

Objective: Our main objective was to examine if parental prenatal preferences predict delivery-room management of extremely preterm periviable infants. The secondary objectives were to describe parental involvement and the content of prenatal counseling given to parents for this prenatal decision.

Design: Prospective study of neonates liveborn between 22 and 26 weeks of gestation in France in 2011 among the neonates included in the EPIPAGE-2 study.

Setting: 18 centers participating in the "Extreme Prematurity Group" substudy of the EPIPAGE-2 study.

Patients: 302 neonates liveborn between 22-26 weeks among which 113 with known parental preferences while parental preferences were unknown or unavailable for 186 and delivery room management was missing for 3.

Results: Data on prenatal counseling and parental preferences were collected by a questionnaire completed by professionals who cared for the baby at birth; delivery room (DR) management, classified as stabilization or initiation of resuscitation (SIR) vs comfort care (CC). The 113 neonates studied had a mean (SD) gestational age of 24 (0.1) weeks. Parents of neonates in the CC group preferred SIR less frequently than those with neonates in the SIR group (16% vs 88%, p < .001). After multivariate analysis, preference for SIR was an independent factor associated with this management. Professionals qualified decisions as shared (81%), exclusively medical (16%) or parental (3%). Information was described as medical with no personal opinion (71%), complete (75%) and generally pessimistic (54%).

Conclusion: Parental involvement in prenatal decision-making did not reach satisfying rates in the studied setting. When available, prenatal parental preference was a determining factor for DR management of extremely preterm neonates. Potential biases in the content of prenatal counselling given to parents need to be evaluated.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Decision Making*
  • Delivery Rooms*
  • Delivery, Obstetric / methods
  • Delivery, Obstetric / standards
  • Delivery, Obstetric / statistics & numerical data*
  • Disease Management
  • Female
  • France / epidemiology
  • Gestational Age
  • Humans
  • Infant
  • Infant, Extremely Premature*
  • Infant, Newborn
  • Male
  • Parents* / psychology
  • Pregnancy
  • Public Health Surveillance

Grant support

This work was supported by a grant from the Fondation de France (http://www.fondationdefrance.org), which had no role in the design and conduct of the study, the collection, analysis or interpretation of data or writing of the report. EPIPAGE 2 was supported by the French Institute of Public Health Research/Institue of Public Health and its partners the French Health Ministry, the National Institute of Health and Medical Research, the National Institute of Cancer, and the National Solidarity Fund of Autonomy; grant ANR-11-EQPX-0038 to Pierre-Yves Ancel from the National Research Agency through the French Equipex Program of Investments in the Future; and the PremUp Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.