Antenatal care

Background

End of life care for pregnant women is complex, requiring sensitive management of care. While NICE provides guidance on end of life care through the NICE guidelines on end of life care for adults (NG142) and care of dying adults in the last days of life (NG31), NICE maternity guidelines do not address the specific requirements of terminally ill pregnant women. This oversight needs to be addressed to respect the mother's wishes while balancing the potential outcomes for the baby, ensuring compassionate support for both women and their families during this difficult time.

Triggers for the exceptional review

The current MBRRACE report, Saving Lives, Improving Mothers' Care (October 2024), suggests that NICE update its end of life care guidance to include recommendations for appropriate service delivery to pregnant or recently pregnant women. This should cover recognising deterioration, supporting time spent with their baby, and holding conversations around the provision of consent for advanced resuscitation.

The current MBRRACE report highlights a case involving a pregnant refugee with a delayed cancer diagnosis at 20 weeks. She chose to end the pregnancy to begin palliative care, receiving compassionate and well-coordinated support. However, the report also observed that, in similar cases, late recognition of disease progression and a focus on pregnancy sometimes delayed essential end of life planning, leading to unnecessary interventions and missed opportunities for meaningful time with loved ones.