Early unexpected diagnosis of fetal life-limiting malformation; antenatal palliative care and parental decision

Abstract

Introduction: Conjoined twins are an infrequent occurrence in obstetric practice. Live-conjoined twins on a late preterm triplet pregnancy is an even rarer event.

Objective: The objective of this study is to emphasize the critical importance of perinatal palliative care and non-directive parental counseling, informed decision making and respect for autonomy following full disclosure of findings, fetal life-limiting diagnosis, treatment alternatives, maternal–fetal potential complications, and most likely perinatal outcomes.

Methods: Early surprise prenatal diagnosis, comprehensive parental counseling, palliative care, and perinatal care of a set of conjoined twins and a singleton.

Results: Cesarean delivery of a set of conjoined twins and a singleton at 34 weeks’ gestation. Immediate neonatal death of the conjoined twins, intact survival, and discharge of the singleton. Review of the database on previously reported similar cases. It is very important to utilize simple and direct language for parents to understand the grave prognosis to the pregnancy. Care alternatives in view of the maternal physical risks and psychological impact of carrying a high order abnormal multiple pregnancy, along with the possible side effects on the singleton.

Keywords:

• Antenatal palliative care
• early diagnosis
• ethics
• lethal anomaly
• parental counseling

Acknowledgements

To the technical and professional staff of the Fetal Diagnostic Unit, Labor and Delivery, Neonatal Intensive Care Unit, Mother/Baby Unit as well as to Frank Gurka and the entire pathology team.

Disclosure statement

The authors have reported no funding or conflicts of interest.