Periviability counselling — communication + emergency station

Communication and emergency station for periviability counselling at 23+4 weeks. Tests the survival number with its denominator, the four obstetric levers, the natural-frequency counselling script, and the parallel actions of steroids, magnesium and in-utero transfer. Includes assessor key and marking domains.

Prompt

A 31-year-old primigravida at 23+4 weeks by a reliable first-trimester scan presents at a level II hospital 90 minutes from the nearest level III centre. She is contracting every three minutes with a cervix of 5 cm. She has had no steroids or magnesium. The fetal heart rate is normal. She asks you: 'What are my baby's chances?' Her partner is at the bedside.

Station brief

Format. Communication and emergency station, approximately 12 minutes. You are the obstetric registrar. The neonatal team at the receiving centre is on the phone. The midwife and the partner are at the bedside. ^[1]

Candidate instruction. Conduct the counselling conversation with the woman and her partner, take the parallel clinical actions, and document the conversation. Verbalise your assessment, your management, your communication, and your handover. ^[1]

References5Show

[1]Rysavy MA, Li L, Bell EF, et al. Between-hospital variation in treatment and outcomes in extremely preterm infants N Engl J Med, 2015.PMID 25946279
[2]Roberts D, Brown J, Medley N, Dalziel SR Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth Cochrane Database Syst Rev, 2017.PMID 28321847
[3]Crowther CA, Middleton PF, Voysey M, Askie L Assessing the neuroprotective benefits for babies of antenatal magnesium sulphate: An individual participant data meta-analysis PLoS Med, 2017.PMID 28976987
[4]Crowther CA, Ashwood P, Middleton PF, et al. Prenatal Intravenous Magnesium at 30-34 Weeks' Gestation and Neurodevelopmental Outcomes in Offspring: The MAGENTA Randomized Clinical Trial JAMA, 2023.PMID 37581672
[5]Fang JL, Mara KC, Weaver AL, Carey WA Outcomes of outborn extremely preterm neonates admitted to a NICU with respiratory distress Arch Dis Child Fetal Neonatal Ed, 2020.PMID 31079068

Periviability counselling — communication + emergency station

Station brief

References5Show

[1]Rysavy MA, Li L, Bell EF, et al. Between-hospital variation in treatment and outcomes in extremely preterm infants N Engl J Med, 2015.PMID 25946279
[2]Roberts D, Brown J, Medley N, Dalziel SR Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth Cochrane Database Syst Rev, 2017.PMID 28321847
[3]Crowther CA, Middleton PF, Voysey M, Askie L Assessing the neuroprotective benefits for babies of antenatal magnesium sulphate: An individual participant data meta-analysis PLoS Med, 2017.PMID 28976987
[4]Crowther CA, Ashwood P, Middleton PF, et al. Prenatal Intravenous Magnesium at 30-34 Weeks' Gestation and Neurodevelopmental Outcomes in Offspring: The MAGENTA Randomized Clinical Trial JAMA, 2023.PMID 37581672
[5]Fang JL, Mara KC, Weaver AL, Carey WA Outcomes of outborn extremely preterm neonates admitted to a NICU with respiratory distress Arch Dis Child Fetal Neonatal Ed, 2020.PMID 31079068