Palliative care in fetal medicine

Abstract

As our Journal has its main scope in maternal and child health, we understand that the following considerations are pertinent:In general, palliative care is related to the adult population. The modern hospice movement in the 1970s, created by Cicely Saunders, represents an essential milestone in the construction of what is currently considered as palliative care. Cicely, a social worker, nurse, and physician, defended that pain relief and symptom control are essential in humanized care, which led her to found St. Christopher's Hospice, in London, a reference in research, teaching, and assistance in palliative care. 1 In 1990, the World Health Organization (WHO) defined palliative care, updated in 2002, as being "care provided by a multidisciplinary team that aim to improve the quality of life of patients and their families to face life-threatening illness, through prevention and relief of suffering, as well as early identification, impeccable assessment, and treatment of pain and other physical, social, psychological, and spiritual symptoms". 2 Pregnancy is a period of intense physical and psychological changes. A pregnant woman and her family create the most varied expectations, among them is the child's health. Fetal medicine is a specialty constantly in advance with increasingly earlier diagnostic possibilities, using ultrasound and invasive tests, besides intrauterine therapies. Therefore, fetal malformations, including severe or lethal ones, can be detected early in prenatal care.In countries where abortion is provided by law, when faced with a diagnosis of fetal malformation, families can choose to terminate the pregnancy or have prenatal follow-up. However, there is a paucity of data in literature on family management who choose to keep the pregnancy in case of severe and/or lethal congenital anomaly. The tendency of many obstetricians is to suggest the termination of the pregnancy. The other option offered is to "do nothing." But, it is necessary to understand that families will deal with grief regardless to the outcome of the pregnancy, and palliative care is a way to support families no matter what the option was. 3 In Brazil, abortion is provided by law, in case of rape, maternal life risk, and, in the context of fetal anomalies, only anencephaly. In cases of other serious or lethal malformations, or those who choose to continue the pregnancy, prenatal should follow as usual.Breaking the news of a severe or lethal malformation to a mother is an extremely delicate and difficult task. Since the diagnosis to the outpatient follow-up and childbirth, family care can be challenging. Fear, insecurity, and guilt are frequent feelings reported by patients. Some pregnant women remain themselves in denial for a long period of time about their diagnosis. Thus, talking about perinatal palliative care during prenatal care is necessary, although there still seems to be a blockage for many professionals. In the 1980s there were already studies aiming to apply palliative care in neonatal intensive care units. In 1997, ...