Lethal fetal abnormalities: how to approach perinatal palliative care?

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

Acknowledgements

We would like to thank the multidisciplinary centers for prenatal diagnosis that agreed to share their perspectives and experiences, and the Directorate of Research, Marseille University Hospital, which approved to conduct the study.

Declaration of interest

The authors report no declarations of interest.