Ten Rules for the Management of Moderate and Severe Traumatic Brain Injury During Pregnancy: An Expert Viewpoint

Abstract

Moderate and severe traumatic brain injury (TBI) are major causes of disability and death. In addition, when TBI occurs during pregnancy, it can lead to miscarriage, premature birth, and maternal/fetal death, engendering clinical and ethical issues. Several recommendations have been proposed for the management of TBI patients; however, none of these have been specifically applied to pregnant women, which often have been excluded from major trials. Therefore, at present, evidence on TBI management in pregnant women is limited and mostly based on clinical experience. The aim of this manuscript is to provide the clinicians with practical suggestions, based on 10 rules, for the management of moderate to severe TBI during pregnancy. In particular, we firstly describe the pathophysiological changes occurring during pregnancy; then we explore the main strategies for the diagnosis of TBI taking in consideration the risks related to mother and fetus, and finally we discuss the most appropriate approaches for the management in this particular condition. Based on the available evidence, we suggest a stepwise approach consisting of different tiers of treatment and we describe the specific risks according to the severity of the neurological and systemic conditions of both fetus and mother in relation to each trimester of pregnancy. The innovative feature of this approach is the fact that it focuses on the vulnerability and specificity of this population, without forgetting the current knowledge on adult non-pregnant patients, which has to be applied to improve the quality of the care process.

Year in Review: Synopsis of Selected Articles in Neuroanesthesia and Neurocritical Care from 2023

“…Di Filippo et al have a practical review article on the current knowledge of TBI-associated hemodynamic tenets, to summarize the most important aspects of this heterogeneous and complex field. 45 Finally, Taran et al have summarized the existing evidence for mechanical ventilation in patients with TBI in their narrative review. 46…”

Trauma Na Gestante: Avaliação E Manejo

“…O uso dos exames radiográficos deve ser indicado quando os benefícios para a gestante ultrapassarem os riscos teratogênicos e carcinogênicos ao feto em relação à radiação, principalmente quando há suspeita de lesões que ameacem a vida. A teratogenicidade apresentase crescente até o final da organogênese, 10 semanas de gestação, caso o feto seja exposto 5 rad ou mais, após esse período até 15 semanas a radiação poderá apresentar efeitos no SNC do feto e redução do crescimento Radiografias do tórax e extremidades apresentam menos exposição do feto à radiação, devendo ser feitas quando necessário (KAFIABADI et al, 2022;SAKAMOTO et al, 2019;JAIN et al, 2015;DI FILIPPO et al, 2022).…”

“…O contraste iodado intravenoso não apresenta efeito colateral em estudos realizados de acordo com FDA, já a administração de gadolínio é considerada controversa, mas é utilizada quando os benefícios à mãe ultrapassam os riscos ao feto. Em casos de TCE a TC é o exame utilizado para avaliação do quadro, pois além de padrão ouro para avaliação inicial de TCE e analisar o grau de lesões que apresentem ameaça à vida, apresentam exposição à radiação abaixo do limite seguro para danos fetais (DI FILIPPO et al, 2022;SAKAMOTO et al, 2019;KAFIABADI et al, 2022;JAIN et al, 2015).…”