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Spotlight Spotlight: Palliative Care Beyond Cancer

Achieving a good death for all

BMJ 2010; 341 doi: (Published 16 September 2010) Cite this as: BMJ 2010;341:c4861

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Achieving a good death for Perinatal care.

Dear Editor,

I read this very informative review article with interest1. However, there
was one omission in the articles content.

Spontaneous and induced pregnancy losses are very common phenomena.
There is clear evidence that parents undergo a grief reaction associated
with the loss of their unborn baby, requiring support and potential
counselling in the long term.

Approximately 5% of pregnancies are complicated by congenital
structural malformations, with as many as 15% being potentially lethal.
Management of these pregnancies poses challenges for the parents, their
Obstetricians and Paediatricians. Issues relating to access to termination
of pregnancy and the gestational limits, at which this may be applied, are
a matter of professional, political, legal and public debate. Currently,
late termination of pregnancy is legal at any gestation until birth, when
there is a substantial risk of severe mental or physical disability for
the child2. The Royal College of Obstetricians & Gynaecologists
guidelines indicates that after 22 weeks of gestation termination of
pregnancy would usually involve fetocide3.

However, many parents decide to continue with such a pregnancy
requiring consideration of alternative management such as perinatal
palliative care. Such a decision is informed by complex cultural,
religious and moral beliefs. This may avoid the potential emotional and
psychological effects of abortion on parents and clinicians. However, the
long-term effects of either perinatal or neonatal loss may be profound and
require support, counselling and the full armamentarium of multidisplinary
planning and discussion, whatever decision for the pregnancy is
undertaken4. Such management is addressed by the British Association of
Perinatal Medicine Working Party, chaired by Dr Edile Murdoch.

I completely agree with the articles title "achieving a good death
for all....." and this should include the care of unborn and newborn

Yours sincerely

Mark Kilby

Professor of Fetal Medicine,
Deputy Head of School,
School of Clinical & Experimental Medicine,
College of Medical & Dental Sciences,
University of Birmingham,
B15 2TT.

Clinical Lead in Fetal Medicine,
Fetal Medicine Centre,
Birmingham Women's Foundation Trust,
Edgbaston, Birmingham, B15 2TG.


1. Achieving a Good Death for All. Ellershaw J et al. BMJ. 341: C4862;

2. Wicks E, Wyldes M and Kilby MD. Late Termination of Pregnancy for Fetal
Abnormality: Medical and Legal Perspectives. Med Law Review 2004; 12: 285-

3. Termination of Pregnancy for Fetal Abnormality in England, Scotland and
Wales. RCOG Report of a Working Party. May 2010.

4. Breeze AC, Lees CC, Kumar A, Missfelder-Lobos HH, Murdoch EM.
Palliative care for prenatally diagnosed lethal fetal abnormality. Arch
Dis Child Fetal Neonatal Ed. 2007;92(1):F56-8.

Competing interests: No competing interests

13 October 2010
Mark D Kilby
Professor of Fetal Medicine
University of Birmingham & Birmingham Women's Foundation Trust