Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Prenatal counseling beyond the threshold of viability

Abstract

Objective:

It is common clinical practice to counsel parents expecting an early-moderate premature birth. The aim of the current study was to assess maternal knowledge of potential problems of prematurity after counseling.

Study design:

Prospective study of 49 participants admitted between 23 and 33 weeks gestation with threatened premature birth; a prematurity knowledge questionnaire and the State-Trait Anxiety Inventory were administered after counseling but before delivery.

Result:

Across all gestational-ages, participants were more aware of short-term problems than long-term problems. With increasing gestational age the knowledge of long-term problems decreased (P=0.01). Maternal knowledge was 82% for gestational ages where clear guidelines exist regarding goal of counseling and information that should be provided to the parents.

Conclusion:

Most mothers of early-moderate premature infants are not aware of the potential for long-term problems. Guidelines, which outline the information that should be provided to parents, may improve maternal knowledge after counseling.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

Figure 1
Figure 2

References

  1. MacDonald H . American Academy of P, Committee on Fetus and N. Perinatal care at the threshold of viability. Pediatrics 2002; 110 (5): 1024–1027.

    Article  Google Scholar 

  2. American College of Obstetricians and Gynecologists. ACOG practice bulletin: clinical management guidelines for obstetrician-gynecologists: number 38, September 2002. Perinatal care at the threshold of viability. Obstet Gynecol 2002; 100 (3): 617–624.

    Google Scholar 

  3. Dobak WJ, Gardner MO . Late preterm gestation: Physiology of labor and implications for delivery. Clin Perinatol 2006; 33 (4): 765–776, abstract.

    Article  Google Scholar 

  4. Marret S, Ancel P, Marpeau L, Marchand LM, Pierrat V, Larroque B et al. Neonatal and 5-year outcomes after birth at 30-34 weeks of gestation. Obstet Gynecol 2007; 110 (1): 72–80.

    Article  Google Scholar 

  5. Chyi LJ, Lee HC, Hintz SR, Gould JB, Sutcliffe TL . School outcomes of late preterm infants: Special needs and challenges for infants born at 32 to 36 weeks gestation. J Pediatr. 2008; 153 (1): 25–31.

  6. Lindstrom K, Lindblad F, Hjern A . Psychiatric morbidity in adolescents and young adults born preterm: a Swedish national cohort study. Pediatrics 2009; 123 (1): e47–e53.

    Article  Google Scholar 

  7. Guillén Ú, Suh S, Munson D, Posencheg M, Truitt E, Zupancic JAF et al. Development and pretesting of a decision-aid to use when counseling parents facing imminent extreme premature delivery. J Pediatr 2011; 160 (3): 382–387.

    Article  Google Scholar 

  8. Harrison H . The principles for family-centered neonatal care. Pediatrics 1993; 92 (5): 643–650.

    CAS  Google Scholar 

  9. Kumar D, Sanders L, Perrin EM, Lokker N, Patterson B, Gunn V et al. Parental understanding of infant health information: Health literacy, numeracy, and the parental health literacy activities test (PHLAT). Acad Pediatr 2010; 10 (5): 309–316.

    Article  Google Scholar 

  10. Yin HS, Johnson M, Mendelsohn AL, Abrams MA, Sanders LM, Dreyer BP . The health literacy of parents in the United States: A nationally representative study. Pediatrics. 2009; 124, (Supplement 3): S289–S298.

  11. Ling ZJ, Lian WB, Ho SK, Yeo CL . Parental knowledge of prematurity and related issues. Singapore Med J 2009; 50 (3): 270–277.

    CAS  PubMed  Google Scholar 

  12. Zupancic JAF, Kirpalani H, Barrett J, Stewart S, Gafni A, Streiner D et al. Characterising doctor-parent communication in counselling for impending preterm delivery. Arch Dis Child Fetal Neonatal Ed 2002; 87 (2): F113–F117.

    Article  CAS  Google Scholar 

  13. Section on Ophthalmology, American Academy of Pediatrics, American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus. Screening examination of premature infants for retinopathy of prematurity. Pediatrics 2006; 117 (2): 572–576.

    Article  Google Scholar 

  14. Bhat V, Karam M, Saslow J, Taylor H, Pyon K, Kemble N et al. Utility of performing routine head ultrasounds in preterm infants with gestational age 30–34 weeks. J Matern Fetal Neonatal Med 2012; 25 (2): 116–119.

    Article  Google Scholar 

  15. Spielberger C, Gorsuch R, Lushene R . STAI manual for the state-trait anxiety inventory. Consulting Psychologists Press Inc: Palo Alto, CA, 1970.

    Google Scholar 

  16. Gunning MD, Denison FC, Stockley CJ, Ho SP, Sandhu HK, Reynolds RM . Assessing maternal anxiety in pregnancy with the state-trait anxiety inventory (STAI): issues of validity, location and participation. J Reprod Infant Psychol 2010 08; 28 (3): 266–273.

    Article  Google Scholar 

  17. Davidoff MJ, Dias T, Damus K, Russell R, Bettegowda VR, Dolan S et al. Changes in the gestational age distribution among U.S. singleton births: Impact on rates of late preterm birth, 1992 to 2002. Semin Perinatol 2006; 30 (1): 8–15.

    Article  Google Scholar 

  18. MacDorman MF, Declercq E, Zhang J . Obstetrical intervention and the singleton preterm birth rate in the united states from 1991-2006. Am J Public Health 2010; 100 (11): 2241–2247.

    Article  Google Scholar 

  19. Gyamfi-Bannerman C, Fuchs KM, Young OM, Hoffman MK . Nonspontaneous late preterm birth: Etiology and outcomes. Obstet Gynecol 2011; 205 (5): 456.e1–e6.

    Google Scholar 

  20. Kramer MS . Late preterm birth: Appreciable risks, rising incidence. J Pediatr 2009; 154 (12): 159–160.

    Article  Google Scholar 

  21. Kuehn BM . Scientists probe the role of clinicians in rising rates of late preterm birth. JAMA 2010; 303 (12): 1129–1136.

    Article  CAS  Google Scholar 

  22. Talge NM, Holzman C, Wang J, Lucia V, Gardiner J, Breslau N . Late-preterm birth and its association with cognitive and socioemotional outcomes at 6 years of age.(Editorial). Obstet Gynecol Surv 2011; 66 (4): 193–195.

    Article  Google Scholar 

  23. Muthusamy AD, Leuthner S, Gaebler-Uhing C, Hoffmann RG, Li S, Basir MA . Supplemental written information improves prenatal counseling: a randomized trial. Pediatrics 2012; 129 (5): e1269–e1274.

    Article  Google Scholar 

  24. Cooper-Patrick L, Gallo JJ, Gonzales JJ, Vu HT, Powe NR, Nelson C et al. Race, gender, and partnership in the patient-physician relationship. JAMA 1999; 282 (6): 583–589.

    Article  CAS  Google Scholar 

  25. Johnson RL, Roter D, Powe NR, Cooper LA . Patient race/ethnicity and quality of patient-physician communication during medical visits. Am J Public Health 2004; 94 (12): 2084–2090.

    Article  Google Scholar 

  26. Ghia N, Spong CY, Starbuck VN, Scialli AR, Ghidini A . Magnesium sulfate therapy affects attention and working memory in patients undergoing preterm labor. Obstet Gynecol 2000 10; 183 (4): 940–944.

    CAS  Google Scholar 

  27. American College of Obstetricians and Gynecologists Committee on Obstetric Practice; Society for Maternal-Fetal Medicine. Committee opinion no. 455: Magnesium sulfate before anticipated preterm birth for neuroprotection. Obstet Gynecol 2010; 115 (3): 669–671.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to M A Basir.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Govande, V., Brasel, K., Das, U. et al. Prenatal counseling beyond the threshold of viability. J Perinatol 33, 358–362 (2013). https://doi.org/10.1038/jp.2012.129

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2012.129

Keywords

  • premature infant
  • communication
  • knowledge
  • parent
  • birth
  • prenatal

This article is cited by

Search

Quick links