Perinatal Palliative Care Following a Severe Fetal Diagnosis: From Antenatal Counselling to Postnatal Care—A Narrative Review

Background: Advances in prenatal diagnosis increasingly identify severe or life-limiting fetal conditions before birth, presenting families and healthcare professionals with complex decisions and uncertain postnatal trajectories. Perinatal palliative care (PnPC) may provide support from diagnosis onward, but its integration into care remains heterogeneous. This narrative review examines the role of PnPC throughout the care trajectory following antenatal diagnosis. Methods: A narrative review informed by a structured search of PubMed/MEDLINE and Embase was conducted for publications from 2015 to 2025. Two reviewers independently screened records and extracted data. The core analytical corpus comprised 24 empirical publications representing 23 distinct study populations. The findings were synthesized according to the clinical trajectory from antenatal diagnosis to postnatal care. Results: Six interconnected domains emerged: timing of referral and access; counselling and support during pregnancy; prognostic uncertainty and parallel planning; anticipatory care and birth planning; postnatal trajectories and adaptation of goals of care; and interdisciplinary coordination, continuity, and family support. The timing of referral to PnPC varied across studies. Postnatal trajectories were heterogeneous, with some infants surviving beyond the neonatal period. Birth planning was described as a tool for communication and preparation, with goals of care requiring reassessment according to the infant’s postnatal condition. Continuity across antenatal and postnatal services remained a recurrent challenge. Conclusions: PnPC should be understood as a longitudinal, family-centred approach rather than a pathway restricted to anticipated neonatal death. Early consideration, balanced and non-directive counselling, flexible parallel planning, individualized birth planning, and coordinated care may help families and professionals navigate uncertainty. Current evidence does not establish the superiority of a single organizational model or the effectiveness of specific supportive interventions. Priorities include timely access, continuity of care, and plans that evolve according to the child’s condition, best interests, and family values.