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Early unexpected diagnosis of fetal life-limiting malformation; antenatal palliative care and parental decision |
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| Authors: | Federico Mariona Marianne Burnett Melody Zoma Janice Blake Hanna Khouri |
| Institution: | 1. Michigan Perinatal Associates, Dearborn, MI, USA;2. Division of Maternal Fetal Medicine, Wayne State University, Detroit, MI, USA;3. Pastoral Care, Beaumont Health, Dearborn, MI, USA;4. Department of Obstetrics &5. Gynecology, Beaumont Health, Dearborn, MI, USA;6. Pediatric Cardiology, Beaumont Health, Dearborn, MI, USA |
| Abstract: | Introduction: Conjoined twins are an infrequent occurrence in obstetric practice. Live-conjoined twins on a late preterm triplet pregnancy is an even rarer event. Objective: The objective of this study is to emphasize the critical importance of perinatal palliative care and non-directive parental counseling, informed decision making and respect for autonomy following full disclosure of findings, fetal life-limiting diagnosis, treatment alternatives, maternal–fetal potential complications, and most likely perinatal outcomes. Methods: Early surprise prenatal diagnosis, comprehensive parental counseling, palliative care, and perinatal care of a set of conjoined twins and a singleton. Results: Cesarean delivery of a set of conjoined twins and a singleton at 34 weeks’ gestation. Immediate neonatal death of the conjoined twins, intact survival, and discharge of the singleton. Review of the database on previously reported similar cases. It is very important to utilize simple and direct language for parents to understand the grave prognosis to the pregnancy. Care alternatives in view of the maternal physical risks and psychological impact of carrying a high order abnormal multiple pregnancy, along with the possible side effects on the singleton. |
| Keywords: | Antenatal palliative care early diagnosis ethics lethal anomaly parental counseling |