Description

Prenatal and Perinatal High-Risk Counseling is a crucial service aimed at providing families with information, support, and planning when there is a known or suspected increased risk of complications for the fetus or mother. This type of counseling helps guide decision-making and prepare families medically, emotionally, and logistically. 🔶 Goals of High-Risk Counseling: Provide accurate information about the diagnosis or risk Discuss prognosis and potential outcomes Offer options for management, interventions, or delivery planning Support emotional coping and decision-making Facilitate coordination of multidisciplinary care 🔹 When is High-Risk Counseling Indicated? Prenatal (Antepartum) Risks: Fetal anomalies (structural or genetic) Multiple gestation Preterm labor risk (short cervix, prior preterm birth) Placental issues (previa, accreta, abruption) Maternal medical conditions (diabetes, hypertension, lupus, epilepsy) Infections (TORCH, Zika, syphilis) Growth restriction (IUGR) Positive non-invasive prenatal screening (NIPS) or abnormal ultrasound Perinatal (Around Delivery) Risks: Preterm delivery Fetal distress Malpresentation Preeclampsia/eclampsia Emergency cesarean section Anticipated NICU admission 🔸 Key Components of Counseling: 1. Medical Explanation Describe the condition, diagnostic certainty, and likely course. Discuss diagnostic tools (e.g., amniocentesis, fetal MRI, echocardiogram). 2. Risk Assessment Estimate prognosis, survival, long-term outcomes (developmental, functional). Present risks of recurrence in future pregnancies if relevant. 3. Management Options Discuss possible in utero interventions, pregnancy monitoring, or timing/mode of delivery. Present postnatal care needs, including NICU support or surgery. 4. Emotional Support Validate emotional responses (fear, grief, guilt). Provide access to psychological counseling, support groups, or chaplaincy. 5. Multidisciplinary Involvement Include maternal-fetal medicine, genetics, neonatology, pediatrics, social work, and ethics teams, if appropriate. 6. Documentation and Planning Clearly document discussions and decisions. Create a birth plan or perinatal palliative care plan (if appropriate). 🔹 Special Counseling Situations: Lethal anomalies: e.g., anencephaly, Trisomy 13/18 Fetal interventions: e.g., laser for TTTS, EXIT procedures Ethical dilemmas: e.g., resuscitation at limits of viability (22–25 weeks) ✅ Tools Often Used in Counseling: Growth and prognosis charts Fetal imaging (ultrasound, MRI) Genetic testing results Decision aids (visual or written) Prognostic calculators (e.g., NICHD outcomes tool)