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Aim: Safer Care Victoria updated a clinical guideline on extreme prematurity in 2020, reducing the threshold for offering resuscitation from 23 to 22 weeks gestation. The zone of parental discretion is the interval of shared decision‐making between parents and doctors regarding resuscitation decisions. It is especially relevant at this periviable gestation. Our study aimed to establish current practices in antenatal counselling and steroid administration at this cusp of viability, and examine the decisions made during the zone of parental discretion. Methods: Single centre retrospective cohort study. Sixteen thousand three hundred fifty‐four admissions and emergency department presentations between January 2021 and July 2023 were retrieved from Birthing Outcomes System (BOS) and patient details were imported and manually reviewed on Microsoft Excel, with particular note to the gestation at admission/emergency department presentation and duration of admission. Eighty‐seven patients were identified as present in the hospital between 21 + 0 and 22 + 6 weeks gestation. These 87 scanned records on Clinical Patient Folder (CPF) were then manually reviewed to identify if antenatal counselling occurred during this window. Thirty‐six patients were included who received antenatal counselling between 21 + 0 and 22 + 6 weeks gestation (the remaining patients did not receive antenatal counselling during this window), and relevant data was subsequently extracted from the scanned medical record and analysed using SPSS software (IBM SPSS Statistics 29). Results: Thirty‐six women received antenatal counselling between 21 + 0 and 22 + 6 weeks. 58% decided on full resuscitation and 39% opted for comfort care if their infant was to be born between 22 + 0 and 22 + 6 weeks. All but one baby born premature were exposed to steroids, with 83.3% receiving a full course. Twenty‐eight infants (62.2%) were fully steroid loaded at the time of delivery. In those fully steroid loaded, 31.1% of the time steroids were initiated prior to transfer, 50% of the time deferred until neonatal review and a decision regarding the resuscitation status of the baby, and on one occasion requested by the neonatologist before counselling. Conclusion: Patients at risk for premature birth who attended our hospital at the cusp of viability were generally counselled about the opportunity for resuscitation between 22 + 0 and 22 + 6 weeks gestational age, and offered steroids. Further studies are required to establish whether the content of antenatal counselling, and the timing of steroids, are consistent in this population. [ABSTRACT FROM AUTHOR]

Background: Congenital anomalies affect approximately 1 in 33 infants leading to 6.6% of deaths in infants and causing significant morbidity in children. There is a need for a study aimed to investigate the diagnosis, prognostication, follow-up and outcomes of antenatally diagnosed surgical anomalies. Aim & Objectives: To identify cases of antenatally detected congenital anomalies within the purview of a surgical perspective, serially monitor them and assess their outcomes over the given period of study. Methods: A total of 60 patients were selected from those pregnant mothers who were referred for antenatal counseling after the fetus was diagnosed to have congenital anomalies during routine gestational scanning in the tertiary care hospital, Ramaiah Medical College and Memorial Hospital over a period of July 1, 2015 to July 1, 2017. All relevant data of the patients was entered into a Proforma and all the quantitative variables were analyzed and presented using descriptive statistics such as mean, mode, median, and standard deviation. All the qualitative variables were presented using frequency and percentage. The association between the various abnormalities and the outcomes was tested using Chi Square Test. Results 41.9% of mothers less than 25 years of age showed fetuses with renal involvement, 29% involved multiple systems, 25.8% involved GIT and 3.2% involved the respiratory system. In mothers older than 25 years of age, 41.4% involved the renal system, 24.1% involved the GIT, 27.6% multiple systems and 6.9% involved the respiratory system. The highest incidence in this study was found to be of renal system involvement. 60.9% of renal anomalies, 21.7% of GIT anomalies, and 8.7% of multiple system and respiratory system anomalies did not require surgical intervention. 35.3% of multiple system anomalies, 29% of renal anomalies, 32.3% of GIT anomalies, and 3.2% of respiratory anomalies required surgical intervention. The study showed that multiple system anomalies were more likely to require surgical intervention. The percentage of need for intervention was least in renal anomalies. Conclusion: Pediatric Surgeons have a very important role in discouraging terminations for correctable anomalies. The time of presentation of various anomalies had no bearing on any particular system involvement. Renal anomalies were the most commonly detected and multiple system anomalies proportionately were more likely to require surgical intervention. [ABSTRACT FROM AUTHOR]

Key content: Congenital anomalies affect more than 2% of fetuses in the UK, with 70% noncardiac in origin. Around 10% are gastrointestinal anomalies such as abdominal wall defects and intestinal atresias.Most gastrointestinal anomalies require postnatal surgical management.Obstetricians must understand the key features of diagnosis and management of common gastrointestinal anomalies.Clinically relevant and evidence‐based information helps facilitate parental reproductive autonomy through timely and informed counselling, planning for delivery and optimising perinatal outcomes.Management of pregnancies complicated by congenital gastrointestinal anomalies requires a multidisciplinary approach with specialist input. Learning objectives: To be familiar with the antenatal diagnosis of gastrointestinal anomalies, associated conditions and potential obstetric complicationsTo understand the antenatal and postnatal management of gastrointestinal anomalies including the approach to surgeryTo appreciate the role of multidisciplinary counselling in fetal medicine Ethical issues: Antenatal counselling in the context of diagnostic and outcome uncertaintiesConsideration of termination of pregnancy for fetal anomaly, including grounds for, and timing of, decision‐making [ABSTRACT FROM AUTHOR]

• Fetal MRI provides additional information to support or modify clinical management in more than half of fetuses with a known body anomaly. • Incidental findings of body anomalies on fetal MRI require careful consideration when recruiting healthy controls. • We recommend that all fetuses with US identified anomalies undergo fetal MRI. We sought to assess variability and concordance between fetal MRI and ultrasound (USS) in the evaluation of fetal body abnormalities. All fetal body anomalies reported on F-MRI within the iFIND database (http://www.ifindproject.com) were included. Differences in findings regarding anomalies on contemporaneous USS were explored. Three clinical specialists evaluated each case independently, and the anomaly severity was graded: as "insignificant" to "lethal". The value of MRI in alteration of either antenatal or postnatal care was established. Fifty-four cases were identified consisting of 5 healthy controls, 37 with USS-identified body anomalies, and 12 with known CNS or cardiac anomalies. In fetuses with a known body anomaly, information on the MRI was relevant to change the clinical course in 59% of cases. There was also an incidental detection rate of 7% in fetuses with known cardiac or CNS anomalies, or 1.5% of normal control, although these were rarely clinically relevant. Importantly, fetuses undergoing MRI for cardiac concerns did have major anomalies that were missed (one case of oesophageal atresia and two cases of ARM). In cases where fetal anomalies are suspected, F-MRI is a valuable means of further characterizing anomalies and may detect additional anomalies in fetuses with recognized cardiac or CNS anomalies. In fetuses with a recognized body anomaly, more than half of those scanned by MRI had information available which changed clinical management. Importantly there were also incidental findings in healthy control fetuses, so the management of these needs to be recognized in fetal MRI research. II, Prospective cohort study. [ABSTRACT FROM AUTHOR]

This article identifies the importance of the role of the fetal cardiac clinical nurse specialist in informing and supporting families through an antenatal fetal cardiac diagnosis. The model used at the Royal Brompton Hospital, London, to ensure the provision of standardised, high quality care to patients throughout their healthcare network is discussed. The challenges faced and guidance available to support such teams are also highlighted. Clinical practice models have been developed through field experience, considering guidance specifications, to direct fetal cardiology services in the provision of quality antenatal support, information and communication. [ABSTRACT FROM AUTHOR]

Background: Evidence on the safety and appropriateness of vaginal birth after caesarean (VBAC) appears clear, but knowledge about women's choice towards this mode of birth is limited. Aims: To identify variables related to women's decision-making about whether to try for VBAC. Method and findings: Cross-sectional study was conducted. Feelings of body failure towards the previous birth and the desire to have a vaginal birth were associated with maternal choice of VBAC. Women who perceived a repeated section as being dangerous for them opted for a VBAC (p=0.030). Opinion of women with the same experience and information found online were implicated into maternal decision-making. Conclusion: This is the first Italian study to confirm that maternal choice is complex and involves many factors. Midwives and obstetricians should strive to provide an evidence-based midwifery care, in order to offer a VBAC as a safe birth option. [ABSTRACT FROM AUTHOR]

Objective(s): To explore health care providers’ (HCPs) perceptions of using shared decision making (SDM) and to identify facilitators of and barriers to its use with families facing the anticipated birth of an extremely preterm infant at 22+0 to 25+6 weeks gestational age. Study Design: Qualitative descriptive study design: we conducted interviews with 25 HCPs involved in five cases at a tertiary care centre and completed qualitative content analysis of their responses. Results: Nine facilitators and 16 barriers were identified. Facilitators included: a correct understanding of this process and how to apply it, a belief that parents should be the decision makers in these situations, and a positive outlook toward using SDM during antenatal counselling. Barriers included: HCPs’ misunderstandings of how and when to apply SDM during antenatal counselling, challenges using the process for cases at the lower end of the gestational age range, fear of the negative emotions and stress parents face when making decisions, and HCPs’ uncertainty about their ability to properly apply SDM. Conclusion(s): This study identified facilitators and barriers to use of SDM during antenatal counselling for anticipated birth of extremely preterm infants that can be used to inform development of tailored strategies to facilitate future implementation of shared decision making in this area. [ABSTRACT FROM AUTHOR]

Objective: To improve the usage of expressed breast milk in very low birth weight infants admitted in the neonatal intensive care unit of a tertiary centre in India.Methods: Between April 2015 and August 2016, various Plan-do-act-study cycles were conducted to test change ideas like antenatal counselling including help of brochure and video, postnatal telephonic reminders within 4-6 hours of birth, standardization of Kangaroo mother care, and non-nutritive sucking protocol. Data was analyzed using statistical process control charts.Results: 156 very low birth weight infants were delivered during the study period, of which 31 were excluded due to various reasons. Within 6 months of implementation, the proportion of very low birth weight infants who received expressed breast milk within 48 hours improved to 100% from 38.7% and this was sustained at 100% for next 8 months. The mean time of availability and volume of expressed breast milk within 48 hours, improved gradually from 73.3 h to 20.9 h and 4.7 mL to 15.8 mL, respectively. The mean proportion of expressed breast milk once infant reached a feed volume of 100 mL/kg/day also improved from 61.3% to 82.3%.Conclusion: Quality improvement interventions showed promising results of increased expressed breast milk usage in very low birth weight infants. [ABSTRACT FROM AUTHOR]

Objectives : Hydronephrosis is commonly detected during antenatal scans. There are multiple conflicting prognostic factors in the literature with no clear focus on the postnatal outcome. The aim of the study is to assess the outcome of fetal hydronephrosis, based on antenatal sonography. Materials and Methods : Based on the third trimester fetal ultrasound findings, patients were divided into group I (unilateral hydronephrosis) and group II (bilateral hydronephrosis, ureteric dilatation, bladder thickening, etc). Postnatal evaluation and follow-up was performed by a single physician with uniform protocol. The outcomes, spontaneous resolution vs. surgical intervention, were compared between groups. Among group I, further analysis of outcome was done based on 32-week fetal pelvic antero posterior diameter (APD). Results : Among a total of 116 patients in the study group; group I had 78 patients, 7 (9%) required surgery; group II had 38 patients, 21(55%) required surgery. The difference in outcome between the groups was statistically significant (P = 0.002). Among those with unilateral hydronephrosis, none (0/55) with APD < 15 mm required surgery, while all patients (4/4) with fetal APD> 30 mm required surgery. In those with APD between 15-30 mm, 3/19 required surgery and prolonged follow-up was required to arrive at the decision. The difference in outcome between the subgroups was statistically significant (P < 0.001, Chi-square test). Conclusions : The results of our study show that simple unilateral fetal hydronephrosis runs a benign course. In the presence hydronephrosis larger than 15 mm, bilateral disease, or bladder distension, detailed postnatal evaluation and regular follow-up is warranted to plan a timely intervention. The above data could be used in prenatal counselling of these parents. Further larger studies are warranted to through more evidence.

Objective: this study aims to provide insight into: (a) midwives' views on appropriate antenatal counselling for congenital anomaly tests, and (b) whether these views match clients' preferences regarding antenatal counselling. Design: a comparative (midwives versus clients) questionnaire survey. Cognitive interviews (n=8) were used to validate the internal validity of the midwifery questionnaire results. Participants and setting: 1416 Dutch midwives (response 62%) completed a questionnaire measuring their views on appropriate antenatal counselling for congenital anomaly tests. prenatal Measurements: we used the 58-item midwives' version of the QUOTE, an instrument to assess clients' counselling preferences. Descriptive statistics were used to explore midwives' views on appropriate counselling and how these relate to client preferences as measured previously with the clients' version of the QUOTEprenatal. Findings: almost all midwives consider the client--midwife relation (100%) and health education (95%) to be (very) important for appropriate antenatal counselling for congenital anomaly tests. Almost half of the midwives consider decision-making support (47%) to be (very) important. These findings are practically congruent with client preferences. Still, clinically relevant differences were found regarding 13 individual items, e.g. more clients than midwives value 'medical information about congenital anomalies' and 'getting advice whether to take prenatal tests or not'. Key conclusion: like clients, most midwives value a good client--midwife relation and health education as (very) important for antenatal counselling for congenital anomaly tests. Less than half of them value decision-making support. These findings are in contrast with the literature in which decision-making support is seen as the most important part of antenatal counselling for congenital anomaly tests. Implication for practice: preferably, antenatal counselling for congenital anomaly tests should be consistent with the three-function model of antenatal counselling i.e. maintaining a client--midwife relation, providing health education as well as decision-making support, and tailored to clients' individual preferences. As not all midwives subscribe to these functions, reflection on their views is important. Furthermore, midwives need to bridge their views on appropriate antenatal counselling and client preferences. To do so, midwives may benefit from the Shared Decision Making approach. [ABSTRACT FROM AUTHOR]

Antenatal parental counselling by healthcare providers is recommended to inform parents and assist with decision-making before the birth of a child with anticipated poor prognosis. In the setting of a low-income country, like Mongolia, attitudes of healthcare providers towards resuscitation of high-risk newborns are unknown. The purpose of this study was to examine the attitudes of healthcare providers regarding ethical decisions pertaining to non-initiation and withdrawal of neonatal resuscitation in Mongolia. A questionnaire on attitudes towards decision-making for non-initiation and withdrawal of neonatal resuscitation was administered to 113 healthcare providers attending neonatal resuscitation training courses in 2009 in Ulaanbaatar, the capital and the largest city of Mongolia where ~40% of deliveries in the country occur. The questionnaire was developed in English and translated into Mongolian and included multiple choices and free-text responses. Participation was voluntary, and anonymity of the participants was strictly maintained. In total, 113 sets of questionnaire were completed by Mongolian healthcare providers, including neonatologists, paediatricians, neonatal and obstetrical nurses, and midwives, with 100% response rate. Ninety-six percent of respondents were women, with 73% of participants from Ulaanbaatar and 27% (all midwives) from the countryside. The majority (96%) of healthcare providers stated they attempt pre-delivery counselling to discuss potential poor outcomes when mothers present with preterm labour. However, most (90%) healthcare providers stated they feel uncomfortable discussing not initiating or withdrawing neonatal resuscitation for a baby born alive with little chance of survival. Religious beliefs and concerns about long-term pain for the baby were the most common reasons for not initiating neonatal resuscitation or withdrawing care for a baby born too premature or with congenital birth-defects. Most Mongolian healthcare providers provide antenatal counselling to parents regarding neonatal resuscitation. Additional research is needed to determine if the above-said difficulty with counselling stems from deficiencies in communication training and whether these same counselling-related issues exist in other countries. Future educational efforts in teaching neonatal resuscitation in Mongolia should incorporate culturally-sensitive training on antenatal counselling. [ABSTRACT FROM AUTHOR]

Abstract: In the UK, around 10–15% of the obstetric population have experienced prior caesarean delivery. This article provides a practical evidence-based approach to the antenatal and intrapartum management of such women. This review is primarily sourced from data presented in guidelines produced by UK (RCOG, NICE) and USA (ACOG, NIH) professional bodies. Antenatal counselling should incorporate an individualized assessment of the risks and benefits of ERCS (elective repeat caesarean section) and planned VBAC (vaginal birth after caesarean) modes of delivery. Planned VBAC is associated with slightly (0.25%) increased perinatal risk than planned ERCS, although absolute risks are low for both modes of delivery. This information, coupled with high rates of VBAC success (70%) and very low-risk of uterine scar rupture (0.5%), indicates planned VBAC is an appropriate option for the vast majority of multiparous women with previous caesarean delivery and is cost effective for the healthcare provider. Of significance, recent guidance from NICE (UK) adds a further dimension to decision making as it has stated that maternal request for caesarean section is permissible in certain circumstances. [Copyright &y& Elsevier]

Objectives: Hydronephrosis is commonly detected during antenatal scans. There are multiple conflicting prognostic factors in the literature with no clear focus on the postnatal outcome. The aim of the study is to assess the outcome of fetal hydronephrosis, based on antenatal sonography. Materials and Methods: Based on the third trimester fetal ultrasound findings, patients were divided into group I (unilateral hydronephrosis) and group II (bilateral hydronephrosis, ureteric dilatation, bladder thickening, etc). Postnatal evaluation and follow-up was performed by a single physician with uniform protocol. The outcomes, spontaneous resolution vs. surgical intervention, were compared between groups. Among group I, further analysis of outcome was done based on 32-week fetal pelvic antero posterior diameter (APD). Results: Among a total of 116 patients in the study group; group I had 78 patients, 7 (9%) required surgery; group II had 38 patients, 21(55%) required surgery. The difference in outcome between the groups was statistically significant ( P = 0.002). Among those with unilateral hydronephrosis, none (0/55) with APD < 15 mm required surgery, while all patients (4/4) with fetal APD > 30 mm required surgery. In those with APD between 15-30 mm, 3/19 required surgery and prolonged follow-up was required to arrive at the decision. The difference in outcome between the subgroups was statistically significant ( P < 0.001, Chi-square test). Conclusions: The results of our study show that simple unilateral fetal hydronephrosis runs a benign course. In the presence hydronephrosis larger than 15 mm, bilateral disease, or bladder distension, detailed postnatal evaluation and regular follow-up is warranted to plan a timely intervention. The above data could be used in prenatal counselling of these parents. Further larger studies are warranted to through more evidence. [ABSTRACT FROM AUTHOR]

Abstract: Defects of the anterior abdominal wall are usually diagnosed antenatally and surgeons counsel parents. Exomphalos and gastroschisis are the two commonest defects and arise from different developmental problems. They present a spectrum of disease that can challenge even the experienced paediatric surgeon. Trainees must understand the natural history and associated problems of both conditions, as well as the different management strategies available. [Copyright &y& Elsevier]

Extremely preterm birth (birth between 22[sup 0/7] and 25[sup 6/7] weeks' gestational age [GA]) often requires parents to make complex choices about the care of their infant. Health professionals have a significant role in providing information, guidance and support. Parents facing the birth of an extremely preterm infant should have the chance to meet with both obstetrical and paediatric/neonatal care providers to receive accurate information about their infant's prognosis, provided with clarity and compassion. Decision making between parents and health professionals should be an informed and shared process, with documentation of all management decisions. Consultation with and transfer to tertiary perinatal centres are important for the care of both mother and fetus. As the survival of infants born before or at 22 completed weeks' GA remains uncommon, a noninterventional approach is recommended, whereas at 23, 24 and 25 weeks' GA, counselling about outcomes and decision making should be individualized for each infant and family, using factors which influence prognosis. All extremely preterm infants who are not resuscitated, or for whom resuscitation is not successful, must receive compassionate palliative care. [ABSTRACT FROM AUTHOR]

Objective: Cystic adenomatoid malformations (CCAM) are relatively rare developmental abnormalities of the lung. Despite outcome is usually benign, parents often exhibit high anxiety level. The purpose of the present study was to collect parents'subjective experience of communication of diagnosis when expecting a fetus with CCAM., Methods: In the period ranging between 2004 to 2007 all couples referred to our hospital for prenatal suspicion of CCAM, were contacted to participate in the study by means of a questionnaire., Results: Twenty-seven couples returned fully completed questionnaire and form the object of this study. 13/27 couples were recommended pregnancy termination.MAJOR RISKS PRESENTED WERE: fetal distress (27/27), intrauterine death (16/27), death at birth (12/27).THE MOST DISTRESSING MOMENTS WERE: communication of diagnosis and the time lag between communication of diagnosis and consultation with the surgeon., Conclusions: Despite CCAM carries a favourable prognosis, couples often appear to receive incomplete information with risk of fetal distress and demise prevailing over survival rate and long term outcome. To provide the couple with the most accurate information concerning the anomaly and the associated prognosis to make informed decision a referral to a tertiary pediatric surgery unit should be made as soon as possible.