title: Survival after non-aggressive obstetric management in cases of severe fetal anomalies: a retrospective study.
abstract: OBJECTIVE
  Obstetricians may choose to refrain from interventions aimed at sustaining fetal life (i.e., non-aggressive obstetric management) when the fetus has an extremely poor prognosis. However, if the infant is then born alive, crucial neonatal management decisions then have to be made. We sought empirical data concerning such perinatal end-of-life decisions. Firstly, to describe survival during delivery and after birth following non-aggressive obstetric management, and secondly, to describe neonatal management in infants born alive after non-aggressive obstetric management.
  
  
  METHODS
  Retrospective descriptive study.
  
  
  METHODS
  Tertiary centre.
  
  
  METHODS
  Eighty-one infants born to women who opted for a non-aggressive obstetric management policy because of sonographically diagnosed severe fetal anomaly.
  
  
  METHODS
  Data were collected from obstetric and neonatal records, as well as ultrasound reports.
  
  
  METHODS
  Survival, neonatal management and health status after birth.
  
  
  RESULTS
  Relevant data were available for 78/80 (98%) infants. Six (8%) infants died in utero, 16 (21%) died during delivery (11 from cephalocentesis) and 56 (72%) were born alive. Life-sustaining neonatal treatment was initiated in 29 (52%) of the live-born infants. Twenty-three of these 29 (79%) infants died within six months of birth. Of the 27 live-born infants who did not receive neonatal life-sustaining treatment, 25 (93%) died. Eight infants survived; all with severe health problems.
  
  
  CONCLUSIONS
  Life-sustaining neonatal support after non-aggressive obstetric management in the presence of severe fetal malformation has little impact on survival.
authors.affiliation: Department of Public Health, Erasmus MC University Hospital, Rotterdam, The Netherlands.
authors.forename: Hilmar H
authors.initials: HH
authors.lastname: Bijma
authors.forename: Agnes
authors.initials: A
authors.lastname: van der Heide
authors.forename: Hajo I J
authors.initials: HI
authors.lastname: Wildschut
authors.forename: Suzanne
authors.initials: S
authors.lastname: van de Vathorst
authors.forename: Dick
authors.initials: D
authors.lastname: Tibboel
authors.forename: Juriy W
authors.initials: JW
authors.lastname: Wladimiroff
authors.forename: Paul J
authors.initials: PJ
authors.lastname: van der Maas
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005315:Fetal Diseases / Q000401:mortality / Q000628:therapy*; D005333:Fetus / Q000002:abnormalities*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008423:Maternal Age; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000379:methods*; D012189:Retrospective Studies; D016019:Survival Analysis