Preferred prenatal counselling at the limits of viability: a survey among Dutch perinatal professionals

Abstract

BackgroundSince 2010, intensive care can be offered in the Netherlands at 24+0 weeks gestation (with parental consent) but the Dutch guideline lacks recommendations on organization, content and preferred decision-making of the counselling. Our aim is to explore preferred prenatal counselling at the limits of viability by Dutch perinatal professionals and compare this to current care.MethodsOnline nationwide survey as part of the PreCo study (2013) amongst obstetricians and neonatologists in all Dutch level III perinatal care centers (n = 205).The survey regarded prenatal counselling at the limits of viability and focused on the domains of organization, content and decision-making in both current and preferred practice.ResultsOne hundred twenty-two surveys were returned out of 205 eligible professionals (response rate 60%). Organization-wise: more than 80% of all professionals preferred (but currently missed) having protocols for several aspects of counselling, joint counselling by both neonatologist and obstetrician, and the use of supportive materials. Most professionals preferred using national or local data (70%) on outcome statistics for the counselling content, in contrast to the international statistics currently used (74%). Current decisions on initiation care were mostly made together (in 99% parents and doctor). This shared decision model was preferred by 95% of the professionals.ConclusionsDutch perinatal professionals would prefer more protocolized counselling, joint counselling, supportive material and local outcome statistics. Further studies on both barriers to perform adequate counselling, as well as on Dutch outcome statistics and parents’ opinions are needed in order to develop a national framework.Trial registrationClinicaltrials.gov, NCT02782650, retrospectively registered May 2016.Electronic supplementary materialThe online version of this article (10.1186/s12884-017-1644-6) contains supplementary material, which is available to authorized users.

Perspectives on periviability counselling and decision‐making differed between neonatologists in the United States and the Netherlands

“…All Dutch neonatal intensive care units provided a list of neonatologists currently working in their departments and all neonatologists were contacted and asked to participate. . We then conducted a similar survey in two hospitals in California in the United States in the spring of 2014, and this study compares the outcomes of the American and Dutch studies.…”

“…The online survey distributed to American physicians was based on the Dutch physician survey . The survey covered the domains of organisation, content, decision‐making process and treatment decisions for prenatal counselling at the threshold of viability.…”

Developing the First Iranian Guideline for Management of Poor Prognosis Infants

“…According to the American Academy of Pediatrics and the American Heart Association, resuscitation of newborns with a GA of < 23 weeks has no indication due to the high risk of mortality and/or unacceptable consequences in the surviving infants [31]. On the other hand, the Dutch guideline on perinatal practice in extremely premature delivery lowers the limit offering intensive care from 24 0/7 weeks to 25 6/7 weeks' gestation [32]. The guideline does recommend transfer to a tertiary center at 23+4/7 weeks to allow su cient time for (repeated) counseling within 24 h in the tertiary center [30].…”

Correction to: Preferred prenatal counselling at the limits of viability: a survey among Dutch perinatal professionals

“…Following publication of the original article [ 1 ], the corresponding authors wrote to say that there was a mistake in the transfer of her article to PubMed: her name is R Geurtzen, but the pdf-file names her as ms R Geurtzen and pubmed names her as MR Geurtzen.…”