Grossesse multiple, malformation létale et soins palliatifs périnatals.

The authors report four observations of multiple pregnancies where one of the foetuses was affected by a lethal malformation. The mothers preferred palliative care after birth rather than selective termination of pregnancy (moreover impossible in one case). Three mothers were primiparous and one was multiparous. The delivery occurred by caesarian section at 30, 32, 33 and 37 weeks of gestational age. Four malformed children died after meeting with their parents at 8 minutes, 1 hour and a half, 2 hours, 4 hours after birth. This practice, which is sometimes proposed to the parents in our department, by avoiding any dangerous procedure during the prenatal period, allows parents to meet with the child, and therefore permits emergency bonding between mother and child. It thus may be a strengthening of the parenthood and attachment favoring later mourning. The limits of the perinatal palliative approach are a too big uncertainty on the nature of the malformations and the potential postnatal life expectancy, as well as the fear that the child suffers at birth and later. [ABSTRACT FROM AUTHOR]