Dobbs-driven expansion of perinatal palliative care: a scoping review of the evidence and its limits.

Abstract

As abortion care restrictions increase, a growing population is continuing pregnancies complicated by life-limiting fetal conditions, making it more critical than ever to evaluate the state of the evidence in perinatal palliative care (PPC). Perinatal palliative care provides interdisciplinary, person-centered care, integrating medical management with psychosocial and bereavement support to enable values-driven decision-making. This scoping review evaluates US-based evidence on the safety, effectiveness, acceptability, and equity of PPC, assessing how these findings relate to growing abortion restrictions. Analysis of 13 studies found that US PPC programs are understudied, with limited evidence on maternal health and neonatal comfort outcomes. Studies lacked use rates for all eligible individuals, preventing assessment of overall PPC uptake. Most PPC patients reported high satisfaction, citing compassionate care, emotional support, and parental validation. However, studies lacked diversity. None examined the experience of receiving PPC due to abortion restrictions. Existing PPC evidence is limited, leaving critical gaps in safety, effectiveness, acceptability, and equity-key factors in assessing whether PPC meets its intended goals and serves diverse populations. Our review highlights that evidence is insufficient to determine whether PPC can adequately support the growing, vulnerable patient population now directed into it by policy rather than choice.