Ethical challenges and moral conflicts in periviability prenatal counseling: a scoping review of healthcare professionals’ perspectives

BACKGROUND: Prenatal counselling at the threshold of viability raises profound ethical challenges for healthcare professionals. Decisions occur under conditions of prognostic uncertainty, high emotional intensity, and variable institutional norms. This scoping review aimed to map the ethical implications and moral conflicts perceived by healthcare professionals involved in periviability counselling, including how counselling is conducted, which contextual factors shape decision-making, and the perceived role and value of Clinical Ethics Consultation (CEC). METHODS: The review followed the PRISMA-ScR guidelines and the Joanna Briggs Institute framework (JBI), using a PCC structure. A comprehensive search was conducted in PubMed, CINAHL, APA PsycInfo, Psychology and Behavioral Sciences Collection and Web of Science. Eligible studies included qualitative, quantitative, or mixed-methods research published in English and reporting on ethical issues, moral dilemmas, or decision-making among healthcare professionals involved in prenatal or periviability counselling. Editorials, commentaries, conference abstracts, theoretical papers, and studies focused solely on parental perspectives were excluded. Two reviewers independently screened all records using CADIMA, with disagreements resolved by consensus with a third reviewer. Data were charted and synthesized through descriptive numerical analysis and inductive thematic synthesis. RESULTS: Twenty-five studies met inclusion criteria: 14 surveys, 9 qualitative studies, 1 mixed-methods study, and 1 randomized controlled trial (RCT). Healthcare professionals represented included neonatologists, obstetric and maternal-fetal medicine clinicians, nurses, trainees and ethicists. Six major themes emerged across study types: (1) variability in resuscitation thresholds and counselling practices; (2) pervasive prognostic uncertainty; (3) value pluralism and interprofessional divergence; (4) communication challenges in high-stakes encounters; (5) institutional culture and system-level influences; (6) moral distress and emotional burden among professionals. CEC was rarely integrated into practice: 17 studies did not mention it, 7 discussed it only conceptually, and only 1 described its operational use. CONCLUSIONS: Periviability counselling is ethically complex and inconsistently implemented across settings. Professionals navigate uncertainty, divergent values, and institutional pressures with limited structured support, while appropriate shared decision-making remains inconsistently achieved. Although CEC holds considerable potential value, it is still rarely used. Strengthening counselling practice will require clearer frameworks, improved communication strategies, interprofessional collaboration and the meaningful integration of ethical support systems.