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.