Obstetricians' agreement on fetal prognosis after ultrasound diagnosis of fetal anomalies (original) (raw)
Related papers
Termination of pregnancy for mild foetal abnormalities- opinions of physicians.pdf
Objective: to know physicians' opinions in sex chromosome, uncertain prognosis and moderate handicap abnormalities and their conformity with the regional laws in case of parental request for termination of pregnancy (TOP). Methods: we sent a questionnaire to physicians in charge of 82 maternal-fetal medicine units in 16 countries. The questions concerned the decision-making in mild congenital abnormalities and its legal aspects. Results: 48 physicians out of 82 (59%) answered the questionnaire. Acceptation of termination of pregnancy before fetal viability was the most frequent attitude in case of uncertain prognosis abnormalities (p= 0.003), sex chromosome abnormalities (p= 0.029) and moderate handicap abnormalities (p= 0.05). Approximately one third to half of decisions of termination of pregnancy for mild congenital abnormalities were more permissive or restrictive than the respective laws (p < 0.05, 95% CI). 65% of the physicians did not want legislative modifications concerning termination for mild congenital abnormalities. In most cases there were no guidelines for the decisions. Conclusion: Acceptation of termination of pregnancy before fetal viability in case involving uncertain prognosis, sex chromosome and abnormalities with moderate handicap was the most frequent attitude of physicians. These attitudes were not always in agreement with the respective regional laws but there were no wishes to modify them.
Fetal abnormality with possibility of legal termination: maternal dilemmas
Revista Brasileira de Enfermagem
Objective: To identify maternal dilemmas about the diagnosis of fetal abnormality incompatible with life. Method: The exploratory-descriptive qualitative method was used. Eight women participated in the research between September/2016 and January/2017 through semi-structured interviews. The data were analyzed from the thematic analysis together with the ATLAS.ti software. Results: The experiences of this study were based on suffering and emotions. The termination choice was based on personal factors of women and families, such as information on pathology and religion. Diagnoses of incompatible fetal abnormalities bring the most different feelings to those involved. It is extremely important to establish a clear communication between woman, family and interdisciplinary team in the course of gestation and delivery, with elucidation about prognosis and therapeutic possibilities. Final considerations: It was visualized the importance of embracement, communication and treatment given by ...
Termination of pregnancy for mild foetal abnormalities: Opinions of physicians
Objective: to know physicians' opinions in sex chromosome, uncertain prognosis and moderate handicap abnormalities and their conformity with the regional laws in case of parental request for termination of pregnancy (TOP). Methods: we sent a questionnaire to physicians in charge of 82 maternal-fetal medicine units in 16 countries. The questions concerned the decision-making in mild congenital abnormalities and its legal aspects. Results: 48 physicians out of 82 (59%) answered the questionnaire. Acceptation of termination of pregnancy before fetal viability was the most frequent attitude in case of uncertain prognosis abnormalities (p= 0.003), sex chromosome abnormalities (p= 0.029) and moderate handicap abnormalities (p= 0.05). Approximately one third to half of decisions of termination of pregnancy for mild congenital abnormalities were more permissive or restrictive than the respective laws (p < 0.05, 95% CI). 65% of the physicians did not want legislative modifications concerning termination for mild congenital abnormalities. In most cases there were no guidelines for the decisions. Conclusion: Acceptation of termination of pregnancy before fetal viability in case involving uncertain prognosis, sex chromosome and abnormalities with moderate handicap was the most frequent attitude of physicians. These attitudes were not always in agreement with the respective regional laws but there were no wishes to modify them.
BJOG: An International Journal of Obstetrics and Gynaecology, 2005
Objective Obstetricians may choose to refrain from interventions aimed at sustaining fetal life (i.e., nonaggressive obstetric management) when the fetus has an extremely poor prognosis. However, if the infant is then born alive, crucial neonatal management decisions then have to be made. We sought empirical data concerning such perinatal end-of-life decisions. Firstly, to describe survival during delivery and after birth following non-aggressive obstetric management, and secondly, to describe neonatal management in infants born alive after non-aggressive obstetric management. Design Retrospective descriptive study.
Prognostic accuracy of antenatal neonatology consultation
Journal of Perinatology, 2016
OBJECTIVE: Neonatologists provide antenatal counseling to support shared decision-making for complicated pregnancies. Poor or ambiguous prognostication can lead to inappropriate treatment and parental distress. We sought to evaluate the accuracy of antenatal prognosticaltion. STUDY DESIGN: A retrospective cohort was assembled from a prospectively populated database of all outpatient neonatology consultations. On the basis of the written consultation, fetuses were characterized by diagnosis groups (multiple anomalies or genetic disorders, single major anomaly and obstetric complications), assigned to five prognostic categories (I = survivable, IIA = uncertain but likely survivable, II = uncertain, IIB = uncertain but likely non-survivable, III non-survivable) and two final outcome categories (fetal demise/in-hospital neonatal death or survival to hospital discharge). When possible, status at last follow-up was recorded for those discharged from the hospital. Prognostic accuracy was assessed using unweighted, multi-level likelihood ratios (LRs). RESULTS: The final cohort included 143 fetuses/infants distributed nearly evenly among the three diagnosis groups. Over half (64%) were assigned an uncertain prognosis, but most of these could be divided into 'likely survivable' or 'likely non-survivable' subgroups. Overall survival for the entire cohort was 62% (89/143). All but one of the fetuses assigned a non-survivable prognosis suffered fetal demise or died before hospital discharge. The neonatologist's antenatal prognosis accurately predicted the probability of survival by prognosis group (LR I = 4.56, LR IIA = 10.53, LR II = 4.71, LR IIB = 0.099, LR III = 0.040). The LRs clearly differentiated between fetuses with high and low probability of survival. Eleven fetuses (7.7%) had misalignment between the predicted prognosis and outcome. Five died before discharge despite being given category I or IIA prognoses, whereas six infants with category IIB or III prognoses survived to discharge, though some of these were discharged to hospice care. CONCLUSIONS: The neonatologist's antenatal prognosis accurately predicted fetal-neonatal outcome. Infants with non-survivable or uncertain but likely poor prognoses had a very low probability of survival, whereas those with good or uncertain prognoses had a high probability of survival. There were few cases of prognostic failure with most occurring in fetuses with one major or multiple anomalies. The few cases of prognostic failure suggest a need for caution. Honest disclosure of prognostic uncertainty and shared decision-making with families utilizing their personal values is critical in the antenatal encounter.
Accuracy of prenatal diagnosis in elective termination of pregnancy: 385 cases from 2000 to 2007
ISRN obstetrics and gynecology, 2011
To evaluate the quality of prenatal results in all cases of termination of pregnancy (TOP) due to fetal abnormalities in a tertiary prenatal diagnosis center. Material and Methods. Retrospective analysis of the 385 TOP performed on our department due to fetal abnormalities between January 1, 2000, and December 31, 2007. We compared all data for agreement between the ultrasound, genetic, and postmortem findings, regarding the abnormalities identified in the etiological diagnosis and its prognosis. Results. Chromosome abnormalities were the most common indication for TOP (39%), followed by abnormalities of CNS (20%), monogenic disorders (11%), sequences (9.6%), polimalformative syndromes (5.2%), and isolated congenital heart diseases (4%). Total agreement was 21%. Further abnormalities were identified in 79%. The data collected after TOP changed the etiologic diagnosis in 21% but the prognosis was changed in only one fetus. Discussion. This study corroborates the necessity of a multidisciplinary team in prenatal diagnosis centers. Their work remarkably improves the genetic counseling and represents an important aspect in quality control of the information given to a couple previously to a TOP.