Paeds Cases · fetal-neonatal-and-perinatal
Extremely preterm infant viability and periviable counselling — OSCE
OSCE station: antenatal counselling of parents facing imminent delivery at 23 weeks gestation, balancing honest outcome data with empathy and shared decision-making.
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Study tools
Target exams
MRCPCH ClinicalRACP DCE
Prompt
A woman at 23+2 weeks gestation with ruptured membranes is in established labour. You are asked to counsel the parents about the options for their baby at birth. The parents are frightened and asking what the team will do.
Objectives
- Conduct a balanced, honest antenatal counselling conversation using plain language. [9]
- Present survival and neurodevelopmental outcome data for a 23-week gestation infant accurately. [1]
- Engage in shared decision-making and create space for genuine parental autonomy. [9]
- Describe both the active intensive care pathway and the comfort care pathway without bias. [10]
References5ShowHide
- [1]Rysavy MA Between-hospital variation in treatment and outcomes in extremely preterm infants. N Engl J Med, 2015.PMID 25946279
- [2]Tyson JE Intensive care for extreme prematurity — moving beyond gestational age. N Engl J Med, 2008.PMID 18420500
- [8]Raju TNK Periviable birth: executive summary of a joint workshop. Obstet Gynecol, 2014.PMID 24785861
- [9]Kaempf JW Counseling pregnant women who may deliver extremely premature infants: medical care guidelines, family choices, and neonatal outcomes. Pediatrics, 2009.PMID 19482761
- [10]Kaempf JW Extremely premature birth and the choice of neonatal intensive care versus palliative comfort care. J Perinatol, 2016.PMID 26583942