Objectives
- •Appraise the role of the palliative care provider in maternal-fetal treatment centers.
- •Review common life-threatening fetal congenital anomalies that may benefit from maternal-fetal intervention.
- •Formulate an operational plan to integrate palliative care services into fetal care centers.
Prominent developments in maternal-fetal intervention have prompted the growth of regional fetal care centers. This growth has increased access to fetal surgery and has introduced a new framework in decision-making for parents: while considering the anticipated likelihood of death or disability posed by the underlying fetal anomaly on the future child, does the proposed benefit of invasive prenatal intervention outweigh maternal-fetal risks? The paradigm is fraught with psychosocial challenges and requires judicious facilitation of goals of care.
Regardless of prenatal surgical intervention, the severity of many fetal conditions is life-threatening. The fetal treatment consultation becomes ground zero in an arduous clinical course for families. The need for comprehensive perinatal palliative care services is ever-present. Directives from obstetric and pediatric professional organizations outline family-centered options for palliative care in the case of many congenital illnesses, but the role of palliative care specialists remains ill-defined.
This session will empower palliative care providers to establish the need for enhanced integration in fetal care centers. It will provide a review of fetal disease including congenital diaphragmatic hernia and critical congenital heart disease that may be treated through maternal-fetal intervention. Seminal trials of antenatal surgical intervention and the state of the science of fetal surgery will be described. Ethical challenges in the risk-benefit calculus of maternal-fetal treatment and shared decision-making will be considered.
The session will propose operational strategies for perinatal palliative care to partner with multi- and interdisciplinary providers across maternal-fetal medicine, neonatology, surgery, nursing, and social work. This will include recommendations for timing the palliative care consult and best practices for individualized case review to ensure optimal value-driven care recommendations.
The progress in maternal-fetal intervention presents unprecedented advances in the care of babies with congenital disease. Palliative care should be central in the family-centered care delivery dynamics.
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