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A Multi-Agency, Multidisciplinary Approach to a Lethal Fetal Diagnosis
Title: A Multi-Agency, Multidisciplinary Approach to a Lethal Fetal Diagnosis
- Recognize the need for a perinatal bereavement program when a lethal fetal anomaly is diagnosed.
- Examine current research on perinatal bereavement programs.
- Apply the findings of this case study and current research to establish a multidisciplinary perinatal bereavement program.
Background: A diagnosis of Trisomy 18 occurs in approximately 1 out of every 3000 live births. The devastating news of any diagnosis that is “incompatible with life” affects the parents, their family, and the healthcare worker alike. Though uncommon, lethal fetal diagnosis needs to be dealt with proactively. An effective perinatal bereavement program can work with the family to make a plan of care that is realistic and expectant. Once shared, this plan can be an effective way for nursing, physicians/midwives, clergy, and social work to create the best of an imperfect scenario for all involved.
Case: A 39 year old multigravida patient presented to her routine office visit after a diagnosis of fetal Trisomy 18. The physician wanted the patient’s labor and delivery experience to be well coordinated with the obstetric nursing department. Once the patient and her husband met with the OB nurse manager, she realized that the family had a knowledge deficit and somewhat unrealistic expectations of the potential outcome of their delivery. The OB nurse manager arranged for the patient and her husband to meet with the perinatal center’s bereavement manager to discuss a plan of care that would meet their needs. The plan was then shared with the obstetrician, the OB staff nurses, the hospital clergy and social service department, and the Pediatrician that would be caring for the infant. Despite having a heart rate during labor, the infant delivered in frank breech position with no heart rate. Per the patient’s request and plan of care made in advance, no resuscitation was performed. The patient was able to spend several hours with the infant and was discharged home on post partum day one. The family was very pleased with all of the planning and care that went into the delivery of her infant, the post mortem care, and the compassion displayed by the healthcare team.
Conclusion: Despite not having a perinatal bereavement program available at a small community hospital, the regional perinatal center’s bereavement program was utilized to create a multi-agency, multi-disciplinary approach to the care of a patient with a lethal fetal diagnosis. Creating a collaborative effort is essential to assist patients in all aspects of care delivery. Communicating the needs of this patient to all departments involved prepared the healthcare providers to meet and exceed the needs of this family.
Keywords: Pregnancy, Trisomy 18, fetal anomalies, bereavement