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Ultrasound diagnosis of fetal anomalies: an analysis of perinatal management of 318 consecutive pregnancies in a multidisciplinary setting

Authors

  • Hilmar H. Bijma,

    Corresponding author
    1. Department of Obstetrics and Gynaecology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
    2. Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
    • Erasmus MC University Hospital, Rotterdam, Room H 596, Department of Obstetrics and Gynaecology, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
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  • Ernst M. Schoonderwaldt,

    1. Department of Obstetrics and Gynaecology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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  • Agnes van der Heide,

    1. Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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  • Hajo I. J. Wildschut,

    1. Department of Obstetrics and Gynaecology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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  • Paul J. van der Maas,

    1. Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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  • Juriy W. Wladimiroff

    1. Department of Obstetrics and Gynaecology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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Abstract

Objectives

The objectives of this study are to analyse the perinatal management decisions made in a multidisciplinary setting following the prenatal diagnosis of fetal anomalies and to evaluate to what extent, in clinical practice, decisions about obstetric management are attuned to those about neonatal management.

Methods

Data on perinatal management of 318 consecutive singleton pregnancies presented to a multidisciplinary perinatal team in a tertiary centre were collected retrospectively.

Results

The multidisciplinary perinatal team decided upon non-aggressive obstetric management in 20% of the cases and consented to termination of pregnancy in 10% of the cases. The multidisciplinary perinatal team decided upon neonatal management in 112(36%) of all fetuses. In 100(89%) of these fetuses, standard neonatal management, and in 12(11%), no neonatal life-sustaining treatment was decided upon. Implementation of the decisions of the multidisciplinary perinatal team on the various management modalities ranged from 88 to 100%.

Conclusion

The multidisciplinary perinatal team worked well in making decisions about obstetric management. In 30% of the cases, this concerned end-of-life decisions. However, for the majority of cases, the perinatal team did not plan neonatal management before birth and thereby did not attune obstetric and neonatal management to each other. This probably reflects the different attitudes towards end-of-life decisions between obstetricians and neonatologists. However, to ensure a consistent perinatal management, a multidisciplinary perinatal team has to make prenatal decisions about both obstetric and neonatal management. Copyright © 2004 John Wiley & Sons, Ltd.

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