Lethal fetal abnormalities: how to approach perinatal palliative care?

Area of Science:

• Perinatal medicine
• Fetal pathology
• Palliative care

Background:

• Antenatal diagnosis of lethal fetal pathologies presents complex ethical and clinical challenges.
• Some women opt to continue pregnancies despite life-limiting fetal diagnoses.
• Perinatal palliative care (PPC) offers a supportive framework in these difficult situations.

Purpose of the Study:

• To investigate the decision-making processes for pregnancies with fetal pathologies deemed incompatible with life.
• To understand professional perspectives on continuing pregnancies and perinatal palliative care.

Main Methods:

• A multicentric survey was conducted among maternal-fetal medicine and fetal care pediatric specialists.
• Questionnaires were emailed to 434 specialists across 48 multidisciplinary prenatal diagnosis centers.
• Response rate was 49.3%, with 61 obstetric-gynecologists and 68 neonatologists completing the survey.

Main Results:

• 35.4% of women chose to continue pregnancy, while 24.7% opted for termination.
• Over half of surveyed professionals (52.9%) initiated discussions about birth support options, including PPC.
• A significant difference was observed in initiative-taking between obstetric-gynecologists and neonatologists (p < 0.01).

Conclusions:

• The study highlights the critical need for enhanced professional training in perinatal palliative care.
• Standardization of PPC practices is essential for consistent and effective patient support.
• Addressing the complexities of managing lethal fetal conditions requires improved interdisciplinary communication and training.