Counselling and management for anticipated extremely preterm birth (original) (raw)
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Staff views on the management of the extremely preterm infant
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2006
Objective: To explore the opinions of different healthcare professionals about the use of interventions and outcome in extremely preterm labour. Study Design: This was a prospective questionnaire survey. A structured questionnaire was mailed to 142 obstetricians, neonatologists, midwives and neonatal nurses working at City Hospital and Queen's Medical Centre, Nottingham, UK. The current opinions of practice of the healthcare professionals in their antenatal and intrapartum management of a woman with an extremely preterm infant were sought. Results: The overall response was 49% (n = 69) after two mailings. Most respondents overestimated infant survival and underestimated intact infant survival rates. Neonatal staff were most likely to wish to use electronic fetal monitoring and administer corticosteroids at the lower extreme gestations. There was no consensus on when to use corticosteroids. Consultant obstetricians were expected to be responsible for counselling parents before delivery, when time allows, but their presence at delivery was not thought to be essential. Neonatal nurses would recommend in utero transfer for women more readily at lower gestations whereas midwives were more reluctant to accept these women as in utero transfers. There were no significant differences in the attitudes to resuscitation of the extremely preterm infant among the different professionals. The median birthweights at which active resuscitation should be commenced ranged from 400 g for neonatal nurses to 500 g for midwives.
Delivery in the ‘grey zone’: Collaborative approach to extremely preterm birth
Australian and New Zealand Journal of Obstetrics and Gynaecology, 2007
During the recent New South Wales and Australian Capital Territory consensus workshop on Perinatal Care at the limits of viability, recommendations were made in the areas of education, counselling and management. Critically, there was a consensus that between 23 weeks and zero days and 25 weeks and six days of gestation, it was reasonable to offer the option of non-initiation of resuscitation and intensive care. Within this, obligation to treat increases as the gestation advances. Implications of the statement for obstetricians are discussed in this article.
Journal of Pregnancy and Child Health, 2017
Introduction: Active management of extreme prematurity, defined as birth occurring before 26WG, has medical and familial repercussions on account of the uncertain future of these infants. The aim of this paper is to describe our experience in the obstetrical and paediatric management of extreme preterm births based on choices made by the families. Methods: We retrospectively included all infants born between 22WG and 25WG+6days in our level III maternity unit in the period from January 2010 to December 2014. These births were documented along with family choices, methods of obstetrical management and birth outcomes. Results: 166 infants were included. After 24WG, active management was requested by the parents in 90% of cases versus 13% at 23WG and none at 22WG. Corticosteroid therapy was administered in 0% of cases at 22WG, 19% at 23WG, 92% at 24WG and 94% at 25WG. Caesarean section was performed in 0% of cases before 24WG, 10% at 24WG and 48% at 25WG. Six per cent of infants at 22WG, 32% at 23WG, 89% at 24WG and 92% at 25WG were live births. The survival rate for infants admitted to neonatal intensive care was 17% at 23WG, 47% at 24WG and 71% at 25WG. Conclusion: Optimal management of extreme preterm births requires a solidly cooperative obstetrical-paediatric team guided by respect for parental choice.
Counselling preterm delivery systematic review
We aimed to describe the outcomes of counselling for preterm delivery. PubMed, Embase, and PsycInfo were systematically searched (from 2000 to 2016) using the following terms: counselling, pregnancy complications, high-risk pregnancy, fetal diseases, and prenatal care. A total of nine quantitative studies were identified, five randomized and four nonrandomized. All studies were conducted in the USA, and half of them were based on a simulated counselling session. Two main clinical implications can be drawn from the available studies: firstly, providing written information before or during the consultation seems to have a positive effect, while no effect was detected when written material was provided after the consultation. Secondly, parents' choices about treatment seemed to be influenced by spiritual-related aspects and/or preexisting preferences, rather than by the level of detail or by the order with which information was provided. Therefore, the exploration of parents' beliefs is crucial to reduce the risks of misconception and to guarantee choice in line with personal values. More research is necessary to validate these findings in cross-cultural contexts and in real world settings of care. Moreover, the centeredness of conversations and the characteristics of the clinician involved in counselling should be addressed in future studies. neurodevelopment, especially for lower gestational ages. Moreover, the unpredictable course and/or the sudden burden of the conditions predisposing to preterm delivery make the counselling even more difficult .