The Management of a Thirteen Weeks Pregnant Woman Rendered Brain-Dead Following a Ruptured Aneurysm

Pikto-Pietkiewicz, Iwona; Okniński, Antoni; Wójtowicz, Rafał; Wójtowicz, Marlena

doi:10.2478/jccm-2019-0015

Cited by 8 publications

(7 citation statements)

References 10 publications

(13 reference statements)

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“…The risk of severe impairment for surviving infants was 36.3% at 22, 14% at 25, and 4.2% at 27-week GA. Alternatively, the chance of survival without impairment for live-born infants increased from 1.2 to 40.6% and 64.2% at 22, 25, and 27-week GA, respectively [ 94 ]. Antenatal exposure to both corticosteroids and magnesium sulfate decreases risk of neurodevelopmental impairment or death in premature births 22–27 weeks [ 95 ].…”

Section: Medical and Surgical Managementmentioning

confidence: 99%

Neurocritical Care of the Pregnant Patient

Malaiyandi

James

Peglar

et al. 2021

Curr Treat Options Neurol

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Purpose of review To summarize recent changes in management and emerging therapies for pregnant neurocritical care patients. Recent findings Diagnostic and treatment options for managing neurologic emergencies in pregnant patients have expanded with both greater understanding of the effects of imaging modalities and medications on pregnancy and application of standard treatments for non-pregnant patients to pregnant populations. Specifically, this includes cerebrovascular diseases (pregnancy-associated ischemic stroke, pregnancy-associated intracerebral hemorrhage, cerebral venous sinus thrombosis), post-maternal cardiac arrest care, seizures and status epilepticus, myasthenia gravis, and fetal somatic support in maternal death by neurologic criteria. Summary With the exception of direct abdominal computed tomography (CT), most imaging studies are reasonably safe in pregnancy. When emergent imaging is needed to prevent maternal morbidity or mortality, any CT sequence with or without contrast is appropriate to pursue. Though new safety data on antiplatelets, antihypertensives, thrombolytics, and antiepileptic drugs have increased options for disease management in pregnancy, unfractionated and low-molecular weight heparin remain the safest options for anticoagulation. Early studies on hypothermia, ketamine, and immunomodulating therapies in pregnancy are promising. In myasthenia gravis, new data on adjunct devices may allow more patients to undergo safe vaginal delivery, avoiding cesarean section and the associated risk of crisis. When difficult decisions regarding preterm delivery arise, recent outcome studies can help inform discussion. Lastly, when the feared complication of maternal death by neurologic criteria occurs, fetal somatic support may help to save at least one life.

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Section: Medical and Surgical Managementmentioning

confidence: 99%

Neurocritical Care of the Pregnant Patient

Malaiyandi

James

Peglar

et al. 2021

Curr Treat Options Neurol

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“…Continuation of somatic support after BD is diagnosed is cornerstone and common praxis in organ-donation programs. Development of BD during pregnancy is rare, and only 30 cases have been described in the medical literature since 1982, involving 19 infants who were born and survived the neonatal period [ 1 , 2 ]. Homeostasis and overall organ function must be maintained in brain-dead pregnant women to ensure proper development of the fetus.…”

Section: Introductionmentioning

confidence: 99%

Delivery of a Healthy Baby from a Brain-Dead Woman After 117 Days of Somatic Support: A Case Report

et al. 2021

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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.

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“…Das Argument einer möglichen Fruchtschädigung durch die Diagnostik sollte aufgrund der zugelassenen Untersuchungsgänge obsolet sein (vgl. BÄK-Richtlinie[3]), wird jedoch im internationalen Schrifttum immer wieder angeführt[17,18]. Inwieweit hierbei betreuungsrechtliche Unsicherheiten (s. Abschnitt "Betreuungsrechtliche Überlegungen") eine Rolle spielten, ist unklar.…”

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Ethische, psychosoziale und rechtliche Aspekte der Behandlung hirntoter Schwangerer

Reinhold¹,

Markus²,

Kredel³

et al. 2021

Anästhesiol Intensivmed Notfallmed Schmerzther

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ZusammenfassungDie Therapie Schwangerer mit irreversiblem Hirnfunktionsausfall ist ein Extrembeispiel nicht nur für die Möglichkeiten moderner Intensivmedizin, sondern auch für die daraus resultierenden ethischen, sozialen und rechtlichen Spannungsfelder, die für Mediziner kein vertrautes Terrain sind. Im Folgenden wird der Fall einer in der 9. SSW verunfallten Patientin mit infauster Prognose bei massivem Schädel-Hirn-Trauma und anamnestischem Wunsch zur Organspende vorgestellt. Vor diesem Hintergrund werden anhand ausgewählter Fälle aus der Literatur verschiedene Aspekte beleuchtet: die Frage der Therapiezielfestlegung, insbesondere Palliation vs. Fortführung; die Implikationen einer Hirntoddiagnostik; betreuungsrechtliche Überlegungen; Einbindung der Angehörigen, v. a. des Kindsvaters; Dynamiken im Behandlungsteam sowie schließlich die Frage einer möglichen Organspende. Das Fallbeispiel verdeutlicht zudem, dass auch bei denkbar ungünstigen Rahmenbedingungen und dem Zusammenkommen scheinbar unvereinbarer Faktoren eine Schwangerschaft überraschend unbeeinträchtigt ausgetragen werden kann. Die recherchierten Fakten und Erwägungen sowie die zitierte weiterführende Literatur in diesem Artikel sollen einen Überblick über potenzielle Dilemmata verschaffen und als fundierter Ausgangspunkt für ähnlich gelagerte Fälle dienen.

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The Management of a Thirteen Weeks Pregnant Woman Rendered Brain-Dead Following a Ruptured Aneurysm

Cited by 8 publications

References 10 publications

Neurocritical Care of the Pregnant Patient

Neurocritical Care of the Pregnant Patient

Delivery of a Healthy Baby from a Brain-Dead Woman After 117 Days of Somatic Support: A Case Report

Ethische, psychosoziale und rechtliche Aspekte der Behandlung hirntoter Schwangerer

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