Perinatal palliative care and neonatal death

The morphologist called at noon: bilateral renal agenesis, anhydramnios, lethal pulmonary hypoplasia. The parents are in the corridor, terrified, and the question that will define their next twelve weeks is the one you must answer first: what do you do when a baby is going to die? Perinatal palliative care is not what happens after you have run out of obstetric interventions — it is a parallel model of care that begins the moment a life-limiting diagnosis is made, runs alongside the obstetric management, and outlasts the death by years. This topic teaches the plan, the investigations, the classification, and the script.^[1][11]

Overview and definition

Perinatal death is the umbrella term. Inside it sit distinct definitions, and any rate comparison must declare its thresholds because they differ between jurisdictions:^[1][2]

• Stillbirth (fetal death): death prior to the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of pregnancy. In ANZ the gestational threshold for reporting varies by jurisdiction (commonly 20 weeks or 400 g, or 22 weeks in some).^[1]
• Early neonatal death: death of a liveborn baby within the first 7 days of life.
• Late neonatal death: death of a liveborn baby between 7 and 28 days of life.
• Perinatal death: a fetal or neonatal death of a defined gestational or birthweight threshold — again, the threshold matters for any comparison.

Perinatal palliative care is the model of care for families facing a life-limiting fetal or neonatal diagnosis. It is what perinatal care becomes when the goal shifts from cure to comfort — and that shift can happen antenatally, intrapartum or postnatally. What it is not: a one-off conversation at the bedside after the baby has died. The systematic reviews are clear that a planned, parallel, multidisciplinary model improves parental outcomes compared with ad hoc care.^[11][9]

References12ShowHide

1. [1]Flenady V, Wojcieszek AM, Ellwood D, et al. Classification of causes and associated conditions for stillbirths and neonatal deaths Semin Fetal Neonatal Med, 2017.PMID 28285990
2. [2]Flenady V, Wojcieszek AM, Middleton P, et al. Stillbirths: recall to action in high-income countries Lancet, 2016.PMID 26794070
3. [3]Lawn JE, Blencowe H, Waiswa P, et al. Stillbirths: rates, risk factors, and acceleration towards 2030 Lancet, 2016.PMID 26794078
4. [4]Sexton JK, Mahomed K, Marsden T, Coory M Prospective cohort study: Causes of stillbirth in Australia 2013-2018 Aust N Z J Obstet Gynaecol, 2021.PMID 33872393
5. [5]Giacoia GP Severe fetomaternal hemorrhage: a review Obstet Gynecol Surv, 1997.PMID 9178311
6. [6]Nelson KE, Rosella LC, Mahant S, Guttmann A Survival and Surgical Interventions for Children With Trisomy 13 and 18 JAMA, 2016.PMID 27458947
7. [7]Burden C, Bradley S, Storey C, et al. From grief, guilt pain and stigma to hope and pride - a systematic review and meta-analysis of mixed-method research of the psychosocial impact of stillbirth BMC Pregnancy Childbirth, 2016.PMID 26785915
8. [8]Shakespeare C, Merriel A, Bakhbakhi D, et al. Parents' and healthcare professionals' experiences of care after stillbirth in low- and middle-income countries: a systematic review and meta-summary BJOG, 2019.PMID 30099831
9. [9]Wool C Systematic review of the literature: parental outcomes after diagnosis of fetal anomaly Adv Neonatal Care, 2011.PMID 21730912
10. [10]Wool C, Parravicini E Implementation of Quality Indicators of Perinatal/Neonatal Palliative Care One-Year Following Formal Training Front Pediatr, 2021.PMID 34926343
11. [11]Zanin A, Salerno A, Cavicchiolo ME, et al. A systematic review of perinatal palliative care models: challenges and opportunities for the future Eur J Pediatr, 2025.PMID 41076485
12. [12]Wood NS, Marlow N, Costeloe K, Gibson AT, Wilkinson AR Neurologic and developmental disability after extremely preterm birth. EPICure Study Group N Engl J Med, 2000.PMID 10933736