A multidisciplinary approach to pre- and perinatal care for fetal life-limiting diagnoses

Introduction As prenatal diagnostic tools continue to expand, clinicians are increasingly faced with managing fetal life-limiting diagnoses. In particular, ethical dilemmas in this process are challenging and can have a significant impact on the mental health of those involved. The emotional pressure in such situations is high, yet life-changing decisions must be made together with the parents. The best available option and care is not necessarily termination of pregnancy (TOP) and an individualized multidisciplinary expectative care with pre- and perinatal counselling should be offered. At our clinic, we have an established concept to care for parents in unfavorable pregnancy situations since two decades, which is constantly expanded and improved. Here, we present a case of a woman who decided to carry a pregnancy with trisomy 18 to term. In this context, we aim to provide an overview on our multidisciplinary team approach in these situations.

Material/Methods A 31 old woman G1P0 was referred to our clinic at 23 weeks for a mid-trimester fetal scan. Several fetal anomalies were detected as well as an intrauterine growth restriction. Amniocentesis confirmed a diagnosis of trisomy 18. After discussing options including TOP, the woman opted to carry on with the pregnancy with a minimum of ultrasound scans. We initiated counselling and care by an advanced practice midwife (APM) specialized in perinatal mental health. All patients with fetal life-limiting diagnoses are offered specialized prenatal care at our clinic.

Results The further course of the pregnancy was uneventful. There was a continuous exchange between APM and obstetrician (OB) on pregnancy care, respecting the patients" particular situations, desires and needs. At 34 weeks, peripartum and postnatal care were defined in a multidisciplinary counseling with parents, APM, neonatologist and OB. A baby girl was delivered at 41 weeks, with a birth weight of 2340g (<1st percentile). The girl is now 6 months old and does not require any additional medical care at this time.

In 2022, 45 prenatal consultations took place at our clinic with expectant patients and their partners, the OB, neonatologist and APM team. Most frequent reasons included desire for TOP (44.4%) and emotional burden (31.1%), [Fig. 1]. There was an increase of 17% in consultations compared to 2021. Furthermore, postpartum follow-up consultations were received as positive in 31.2%, negative in 2.1% and not desired in 10.4%.

Fig. 1  Reasons for multidisciplinary prenatal consultations with advanced practice midwife, obstetricians and neonatologists.

Discussion In cases of fetal life-limiting diagnoses, we have to be attuned to the expecting patients' desires and needs. As a multidisciplinary team of professionals, we have a responsibility to provide individualized pre- and perinatal care, especially since TOP is often not requested by women. From our experience, expectant women and their partners highly value a personalized yet professional and multidisciplinary approach.