Antenatal diagnosis and management of life-limiting conditions

Breeze, Andrew C. G.; Lees, C.

doi:10.1016/j.siny.2012.09.004

Cited by 18 publications

(10 citation statements)

References 78 publications

(70 reference statements)

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“…It is noteworthy that, in addition to allowing better planning of pregnancy and delivery, this early diagnosis allows for the initiation of perinatal palliative care 1 10 , 12 , 14 …”

Section: Discussionmentioning

confidence: 99%

Análise Dos Óbitos E Cuidados Paliativos Em Uma Unidade De Terapia Intensiva Neonatal

Marçola

Barbosa

Zoboli

et al. 2017

Rev. paul. pediatr.

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Objective: To characterize cases of children admitted to the Neonatal Intensive Care Unit of a tertiary university hospital who died in the period ranging from January 01, 2012 to July 31, 2014, and who required palliative care and/or were subjected to it.Methods: A retrospective descriptive study was carried out by reviewing the medical records of these patients to collect data and to perform descriptive statistical analysis.Results: During the study period, 49 children died after at least 48 hours from the time of admission. Of those, 18% children were extremely premature infants and 77% children had malformations. Although necessary for all of the patients in this study, palliative care was provided for only 20% of patients who died. Among the 12 babies who were not resuscitated, 33% of babies were not in palliative care. The Pain and Palliative Care Unit of the institution followed only four neonates in palliative care. These patients were using many invasive devices, had high therapeutic investment, and also altered pain scale scores.Conclusions: This study exhibited a large proportion of newborn infants with serious diseases and health conditions. In a few cases the patients received palliative care, but most of them were not even discussed under palliative point of view. We hope that this study will call attention to the need to propose protocols and implement training for the best treatment of these children.

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“…It is noteworthy that, in addition to allowing better planning of pregnancy and delivery, this early diagnosis allows for the initiation of perinatal palliative care 1 10 , 12 , 14 …”

Section: Discussionmentioning

confidence: 99%

Análise Dos Óbitos E Cuidados Paliativos Em Uma Unidade De Terapia Intensiva Neonatal

Marçola

Barbosa

Zoboli

et al. 2017

Rev. paul. pediatr.

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“…They appear to share a high chance of death and profound impairment regardless of attempted treatment. We could refer to ‘life-limiting’ conditions [79] , ‘poor prognosis’ malformations, or ‘potentially lethal’ [79] malformations. However, any new term will have the same problems of defining the probability and severity of poor outcome that would justify its application.…”

Section: Beyond the Concept Of ‘Lethal Malformations’mentioning

confidence: 99%

Ethical language and decision-making for prenatally diagnosed lethal malformations

Wilkinson¹,

Crespigny²,

Xafis³

2014

Seminars in Fetal and Neonatal Medicine

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SummaryIn clinical practice, and in the medical literature, severe congenital malformations such as trisomy 18, anencephaly, and renal agenesis are frequently referred to as ‘lethal’ or as ‘incompatible with life’. However, there is no agreement about a definition of lethal malformations, nor which conditions should be included in this category. Review of outcomes for malformations commonly designated ‘lethal’ reveals that prolonged survival is possible, even if rare. This article analyses the concept of lethal malformations and compares it to the problematic concept of ‘futility’. We recommend avoiding the term ‘lethal’ and suggest that counseling should focus on salient prognostic features instead. For conditions with a high chance of early death or profound impairment in survivors despite treatment, perinatal and neonatal palliative care would be ethical. However, active obstetric and neonatal management, if desired, may also sometimes be appropriate.

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“…(13) Furthermore, maternal risks involved in continuing pregnancy should be considered and discussed with the parents, thus helping in the decision-making process of interrupting or not pregnancy. (6) …”

Section: Introductionmentioning

confidence: 99%

Association of gestational age with the option of pregnancy termination for fetal abnormalities incompatible with neonatal survival

Westphal

Fustinoni

Pinto

et al. 2016

Einstein (São Paulo)

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Objective:To identify the profile of women seen in a Fetal Medicine unit, diagnosed with fetal abnormality incompatible with neonatal survival in their current pregnancy, and to check the association of gestational age upon diagnosis with the option of pregnancy termination.Methods:This is a retrospective cohort study carried out in the Fetal Medicine Outpatients Clinic of a university hospital, in the city of São Paulo (SP), Brazil, using medical records of pregnant women with fetus presenting abnormalities incompatible with neonatal survival. The sample comprised 94 medical records. The Statistical Package for the Social Sciences (SPSS), version 19, was used for the data statistical analysis.Results:The population of the study included young adult women, who had complete or incomplete high school education, employed, with family income of one to three minimum wages, single, nonsmokers, who did not drink alcoholic beverages or used illicit drugs. Women with more advanced gestational age upon fetal diagnosis (p=0.0066) and/or upon admission to the specialized unit (p=0.0018) presented a lower percentage of termination of pregnancy.Conclusion:Due to characteristics different from those classically considered as of high gestational risk, these women might not be easily identified during the classification of gestational risk, what may contribute to a late diagnosis of fetal diseases. Early diagnosis enables access to specialized multiprofessional care in the proper time for couple's counseling on the possibility of requesting legal authorization for pregnancy termination.

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Antenatal diagnosis and management of life-limiting conditions

Cited by 18 publications

References 78 publications

Análise Dos Óbitos E Cuidados Paliativos Em Uma Unidade De Terapia Intensiva Neonatal

Análise Dos Óbitos E Cuidados Paliativos Em Uma Unidade De Terapia Intensiva Neonatal

Ethical language and decision-making for prenatally diagnosed lethal malformations

Association of gestational age with the option of pregnancy termination for fetal abnormalities incompatible with neonatal survival

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