Antenatal

• Clear, consistent communication guides shared decision-making while recognising uncertainty and family values.
• A structured approach supports safe, family-centred care across gestations and scenarios.

• Consider gestation, birth weight, sex, plurality, steroid exposure, growth, anomalies and anticipated condition at birth.
• At the limits of viability, lead with the most senior clinician available - resuscitation options, expected course and areas of uncertainty.

For periviability counselling

• NICHD Extremely Preterm Birth Outcomes tool - survival and outcomes by gestation, birthweight, sex, plurality and antenatal steroids.
• BAPM - Perinatal management of extreme preterm birth before 27 weeks - a risk-based framework (22+0 to 26+6 weeks).

Not a script

• Estimates are population-level - individualise to the family and acknowledge uncertainty.
• Lead the most difficult discussions with the most senior clinician available.
• Document what was discussed and agreed.