Du diagnostic anténatal à la néonatologie, le choix des soins palliatifs : une lecture à deux voix

The diagnosis of an incurable fetal abnormality creates an important psychological trauma for the parents. In this particular context, the issue of current multidisciplinary perinatal medicine is to foster real parental bonds. Unlike the difficult choice to terminate the pregnancy for medical reasons, palliative perinatal care supports parenting into a life project even if it is very brief. Establishing a palliative care project before the birth of the child contributes to accept the prognosis, to support parents in their full-fledged roles, to share the responsibility of the decision with caregivers and relatives and to care for the newborn and his family. Nevertheless, from the prenatal diagnosis to the development of neonatal palliative care, the process can be fraught with difficulties: inconsistency of speech between interdisciplinary teams, or between antenatal and postnatal management, diagnostic and prognostic uncertainties, the fragility of the alliance with the parents, the choice of words, unspoken words, projection of health care teams, breach of a temporality needed for all stakeholders, etc. In this article we propose an analysis of these situations and consider solutions.SCOPUS: ar.j