INTRODUCTION
Parents at risk for delivering an extremely premature infant receive
prenatal counseling. Prenatal counseling is of major importance for the
parent(s), especially when the infant is born in the so-called ‘gray
zone’, that is, at the limit of viability. When infants are born at the
limit of viability, only a proportion of them will survive; some without
disabilities, others with serious long-term
disabilities.1 The gray zone is primarily
characterized by prognostic uncertainty: no treatment option prevails
based on what is known about the prognosis of the infant. The
delineation of the gray zone however, differs between countries going
from – for example – 22 and 23 weeks of gestational age (GA) in Sweden
to 24 and 25 weeks of GA in the Netherlands.2-4
A major goal of prenatal counseling for extreme prematurity in the gray
zone is to facilitate parental decision-making.5,6 A
decision has to be made between an active care approach and a palliative
comfort care approach for the extremely premature infant. When parents
receive prenatal counseling for extreme prematurity beyond this
gray zone, more emphasis lies on informing the
parents.7 Since the goal of prenatal counseling
changes beyond the gray zone, this article will focus solely on prenatal
counseling for extreme prematurity in the gray zone, at the limit of
viability.
Overall, prenatal counseling practices are heterogenous, varying per
country, medical center and physician.8,9 Without
disregarding such variability, we aimed to identify the main
characteristics of prenatal counseling for extreme prematurity at the
limit of viability that can be found in the existing body of literature.