Survival after non-aggressive obstetric management in cases of severe fetal anomalies: a retrospective study.
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.
Bijma
Hilmar H
HH
Department of Public Health, Erasmus MC University Hospital, Rotterdam, The Netherlands.
van der Heide
Agnes
A
Wildschut
Hajo I J
HI
van de Vathorst
Suzanne
S
Tibboel
Dick
D
Wladimiroff
Juriy W
JW
van der Maas
Paul J
PJ
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