The role of perinatal palliative care following prenatal diagnosis of major, incurable fetal anomalies: a multicentre prospective cohort study.

Autor: de Barbeyrac C; Department of Neonatal Medicine, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, Paris, France., Roth P; Department Obstetrics and Fetal Medicine, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, EA7328, Paris, France., Noël C; Department Obstetrics and Fetal Medicine, Centre Hospitalier René Dubos, Pontoise, France., Anselem O; Department of Department Obstetrics and Fetal Medicine, AP-HP, Hôpital Cochin - Port-Royal, Paris, France., Gaudin A; Department of Neonatal Medicine, AP-HP, Hôpital Robert-Debré, Paris, France., Roumegoux C; Department of Neonatal Medicine, AP-HP, Hôpital Jean-Verdier, Bondy, France., Azcona B; Department of Neonatal Medicine, Centre Hospitalier Intercommunal de Créteil, Créteil, France., Castel C; Department of Neonatal Medicine, Centre Hospitalier Intercommunal de Poissy-Saint-Quentin, Poissy, France., Noret M; Department of Obstetrics, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France., Letamendia E; Maternity Unit, AP-HP, Hôpital Antoine Béclère, Clamart, France., Stirnemann J; Department Obstetrics and Fetal Medicine, Centre Hospitalier René Dubos, Pontoise, France., Ville Y; Department Obstetrics and Fetal Medicine, Centre Hospitalier René Dubos, Pontoise, France., Lapillonne A; Department of Neonatal Medicine, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, Paris, France., Viallard ML; Palliative Medicine Unit, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, Paris, France., Kermorvant-Duchemin E; Department of Neonatal Medicine, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, Paris, France.
Jazyk: angličtina
Zdroj: BJOG : an international journal of obstetrics and gynaecology [BJOG] 2022 Apr; Vol. 129 (5), pp. 752-759. Date of Electronic Publication: 2021 Nov 08.
DOI: 10.1111/1471-0528.16976
Abstrakt: Objective: To describe prenatal decision-making processes and birth plans in pregnancies amenable to planning perinatal palliative care.
Design: Multicentre prospective observational study.
Setting: Nine Multidisciplinary Centres for Prenatal Diagnosis of the Paris-Ile-de-France region.
Population: All cases of major and incurable fetal anomaly eligible for TOP where limitation of life-sustaining treatments for the neonate was discussed in the prenatal period between 2015 and 2016.
Methods: Cases of congenital defects amenable to perinatal palliative care were prospectively included in each centre. Prenatal diagnosis, decision-making process, type of birth plan, birth characteristics, pregnancy and neonatal outcome were collected prospectively and anonymously.
Main Outcome Measure: Final decision reached following discussions in the antenatal period.
Results: We identified 736 continuing pregnancies with a diagnosis of a severe fetal condition eligible for TOP. Perinatal palliative care was considered in 102/736 (13.9%) pregnancies (106 infants); discussions were multidisciplinary in 99/106 (93.4%) cases. Prenatal birth plans involved life-sustaining treatment limitation and comfort care in 73/736 (9.9%) of the pregnancies. The main reason for planning palliative care at birth was short-term inevitable death in 39 cases (53.4%). In all, 76/106 (71.7%) infants were born alive, and 18/106 (17%) infants were alive at last follow-up, including four with a perinatal palliative care birth plan.
Conclusions: Only a small proportion of severe and incurable fetal disorders were potentially amenable to limitation of life-sustaining interventions. Perinatal palliative care may not be considered a universal alternative to termination of pregnancy.
Tweetable Abstract: Perinatal palliative care is planned in 10% of continuing pregnancies with a major and incurable fetal condition eligible for TOP.
(© 2021 John Wiley & Sons Ltd.)
Databáze: MEDLINE
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