The ethics of neurologically complicated pregnancies

Smok, Dorothy; Prager, Kenneth

doi:10.1016/b978-0-444-64239-4.00013-8

Cited by 4 publications

(7 citation statements)

References 40 publications

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“…3 Disorders of consciousness and brain death are rare events in pregnancy. 5 The incidence of brain death in pregnant women in the UK is unknown; such data are not routinely col-lected by intensive care units, or NHS Blood and Transplant (NHSBT). A recent case series estimated the prevalence of pregnancy among brain dead patients at 2.5%.…”

Section: Introductionmentioning

confidence: 99%

Brain Death in Pregnancy: A Systematic Review

Dhillon,

Auliya,

Azhari

2023

JARMHS

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Background: Brain death is a rare event in pregnancy. A recent case series estimated the prevalence of pregnancy among brain dead patients at 2.5. The care of a brain-dead pregnant women focuses on optimizing maternal recovery, considering fetal health impacts, and interventions for maternal support, including medication, radiation exposure, and preterm labor risks. The aim: This study aims to investigate brain death in pregnancy. Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2013 and 2023 were taken into account. Several different online reference sources, like Pubmed and ScienceDirect, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Results: In the PubMed database, the results of our search brought up 17 articles, whereas the results of our search on ScienceDirect brought up 11 articles. The results of the search conducted by title screening yielded a total 12 articles for PubMed and 6 articles for ScienceDirect. We compiled a total of 12 papers, 7 of which came from PubMed and 5 of which came from ScienceDirect. We excluded 2 review articles, 3 duplicate articles, 1 article having ineligible subject, and 1 discussion article. In the end, we included five research that met the criteria. Conclusion: In this review, 80 of neonates were born alive. Somatic support of the brain-dead pregnant woman was perfomed to maximize perinatal outcomes. And during gestation, obstetricians must closely monitored fetal development.

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Section: Introductionmentioning

confidence: 99%

Brain Death in Pregnancy: A Systematic Review

Dhillon,

Auliya,

Azhari

2023

JARMHS

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“…In some cases, interventions aimed to sustain patient's vital functions, after a BD diagnosis, are justified for the sake of the fetus, whose survival depends first on the gestational age. However, the dilemma whether or not to offer somatic care to a brain-dead pregnant patient has become a controversial ethical issue and matter of strong debate ( 78 ).…”

Section: Introductionmentioning

confidence: 99%

“…Always respecting either patient or relatives' wishes, a brain-dead mother should be considered as a potential organ donor after the delivery ( 70 ). In any case, current local laws, that may vary in different regions, should be always considered ( 78 ).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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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.

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“…In some cases, interventions on the mother’s body are justified to preserve the life of the fetus [ 92 ]. This point is extremely controversial and complex because of the bioethical dilemmas specifically related to pregnancy [ 93 ]. Decision-makers must consider the maternal–fetal unit, and all aspects of care must be discussed in a multidisciplinary manner, with inclusion of medical, ethical, and legal experts [ 93 ].…”

Section: Introductionmentioning

confidence: 99%

“…This point is extremely controversial and complex because of the bioethical dilemmas specifically related to pregnancy [ 93 ]. Decision-makers must consider the maternal–fetal unit, and all aspects of care must be discussed in a multidisciplinary manner, with inclusion of medical, ethical, and legal experts [ 93 ]. Regarding the care of a pregnant woman who has suffered a catastrophic and irreversible brain injury, decision-makers should consider the following factors: (1) prognosis of the injury, gestational age and its impact, and of the therapeutic interventions on the fetus; (2) the mother’s wishes; (3) commitment to decision-making by the mother’s close relatives or surrogates; and (4) current local laws [ 93 ].…”

Section: Introductionmentioning

confidence: 99%

Acute Intracranial Hypertension During Pregnancy: Special Considerations and Management Adjustments

et al. 2021

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Pregnancy is associated with a number of pathophysiological changes (including modification of vascular resistance, increased vascular permeability, and coagulative disorders) that can lead to specific (eclampsia, preeclampsia) or not specific (intracranial hemorrhage) neurological complications. In addition to these disorders, pregnancy can affect numerous preexisting neurologic conditions, including epilepsy, brain tumors, and intracerebral bleeding from cerebral aneurysm or arteriovenous malformations. Intracranial complications related to pregnancy can expose patients to a high risk of intracranial hypertension (IHT). Unfortunately, at present, the therapeutic measures that are generally adopted for the control of elevated intracranial pressure (ICP) in the general population have not been examined in pregnant patients, and their efficacy and safety for the mother and the fetus is still unknown. In addition, no specific guidelines for the application of the staircase approach, including escalating treatments with increasing intensity of level, for the management of IHT exist for this population. Although some of basic measures can be considered safe even in pregnant patients (management of stable hemodynamic and respiratory function, optimization of systemic physiology), some other interventions, such as hyperventilation, osmotic therapy, hypothermia, barbiturates, and decompressive craniectomy, can lead to specific concerns for the safety of both mother and fetus. The aim of this review is to summarize the neurological pathophysiological changes occurring during pregnancy and explore the effects of the possible therapeutic interventions applied to the general population for the management of IHT during pregnancy, taking into consideration ethical and clinical concerns as well as the decision for the timing of treatment and delivery.

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The ethics of neurologically complicated pregnancies

Cited by 4 publications

References 40 publications

Brain Death in Pregnancy: A Systematic Review

Brain Death in Pregnancy: A Systematic Review

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

Acute Intracranial Hypertension During Pregnancy: Special Considerations and Management Adjustments

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