Patient: Female, 27-year-old Final Diagnosis: Brain death Symptoms: Loss of consciousness Medication:— Clinical Procedure: — Specialty: Critical Care Medicine • Obstetrics and Gynecology Objective: Rare disease Background: The care and management of brain-dead pregnant women is surrounded by legal and ethical controversies. Gestational age is directly proportional to newborn survival. We report a case of a brain-dead pregnant woman at the 16 th week of gestation and the successful delivery of a healthy child after 117 days of maternal somatic support. Case Report: A 27-year-old pregnant woman at 16 weeks’ gestation with large intracerebral hematoma after rupture of an arteriovenous malformation was admitted to our intensive care unit. Signs of brain death developed early, and the woman was confirmed to be brain dead after day 6 of hospitalization. The decision-making process regarding course of medical treatment was complex and accompanied by uncertainties arising from the absence of a legal, ethical, and professional framework. A complex multidisciplinary approach was followed. The main aim was to maintain the brain-dead woman’s homeostasis to allow for proper development of the fetus. Monitoring of fetal growth was considered the best endpoint, and satisfactory fetus development was achieved. A healthy child was delivered with a birth weight of 2140 g. Her Apgar score was 10/10/10 at 1, 5, and 10 minutes, respectively, and favorable outcomes were observed at a 1-year follow-up. Conclusions: Brain death during pregnancy is an extremely rare but increasingly common condition. Guidelines for care management are lacking, and reporting these cases may help establish medical treatment in future cases. We show that somatic support of the body of a brain-dead pregnant woman for an extended period of time can lead to successful delivery of a healthy child.
155 Background: The transarterial chemoembolization (TACE) and the radiofrequency ablation (RFA) are the keystones of interventional therapy of primary and secondary liver malignancies in oncology. A compromised liver function may be a relative contraindication to these therapies. Child-Pugh liver scoring system is widely used to exclude patients with low liver function. The indocyanine green (ICG) retention rate at 15 min. (ICGR15) is a frequently used liver function test in liver surgery, however it is not widely available. The quantification of dynamic cholescintigraphy and the calculation of hepatic extraction fraction (HEF) describes specifically a functional efficiency of the liver parenchyma. Methods: We retrospectively studied 107 patients with primary or secondary liver malignancies who underwent TACE or RFA between February 2005 and February 2012. ICG test and dynamic cholescintigraphy and Child-Pugh score were assessed before the procedure. The comparison of relative frequencies of categories was performed by binomial test (independent testing) or by McNemar’s test (paired design). The association in occurrence of different categories was tested by the help of Fisher’s exact test. Results: The comparison of categorized outcomes of ICGR15 and HEF examination revealed high degree of agreement between these techniques (p = 0.773). The statistically significant similarity in the outcome of both methods was also proved by the analysis of contingency tables. 81% of tested samples obtained the same scoring by both approaches. Clinically important discrepancies between these methods were rare and were not observed in the two extreme categories, i.e. normal and very low liver function. Conclusions: The ICGR15 correlates well with the HEF in liver function assessment. Thus either method can be used in patients who are to undergo liver directed therapies when the assessment by Child-Pugh score is not sufficient enough.
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