Traumatic Brain Injury in Pregnancy

Abstract

Objective The present paper aims to provide a review on the main complications involving traumatic brain injury (TBI) during pregnancy and on the vegetative state after TBI. Methods A systematic review was performed in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria checklist. Results Seven studies were included, of which four were case reports, one was a follow-up, one was a comparative study, and one was a literature review. Discussion Presence of neurological deficits such as hemiparesis, neonatal seizures, cerebral palsy, hemorrhage or hydrocephalus was observed in children of mothers who suffered trauma during pregnancy. The prolongation of a pregnancy in these victims, even in brain death, is within the reach of current medicine. Ethical issues must be considered when deciding to prolong a pregnancy of a woman in brain death. Conclusion For the evaluation of pregnant women with TBI, there is a protocol that can be followed in the emergency care service. The cases reported in the literature suggest that there is no clear limit to restrict support to a pregnant patient in a vegetative state. Further studies should be done to elucidate this matter.

Neurocritical Care Perspective of Traumatic Brain Injury During Pregnancy

“…In addition to the injuries to mother, the foetus also can sustain injuries including skull fractures, spine injuries, injury to pubic symphysis, fracture involving the pelvis or other long bones 18,19) , diffuse axonal injury (due to strong accelerations/decelerations forces) can injure the premature brain 19) . The impact of these injuries can be compounded by presence of maternal hypovolemic shock, disseminated intravascular coagulation, and compromised placental blood flow and a hypercoagulable state [20][21][22] . Although oestrogen and progesterone have been suggestive as neuroprotective steroid hormones, however; the role of increased levels of oestrogen and progesterone during pregnancy as neuroprotective agents is controversial 20) .…”

“…As an exception, in third-trimester pregnancy and if the injury is severe and anticipated maternal survival is poor, caesarean section may take the precedence 29) . In a special circumstance where the severe traumatic brain injury leads to either persistent vegetative state of if the patients becomes brain dead and foetus is alive, special care needs to be taken to prolong the pregnancy till the safe delivery of viable foetus is possible 13,14,18,22,30,31) . In reference to the perimortem caesarean section, the literature suggests that chances of foetal survival are best it is performed within 5 min of maternal arrest 32) and as the delay occurs chances of foetal survival decreases (67% if the section is performed before 15 minutes of cardiopulmonary compromise versus 40% at 16-25 minutes) 33,34) .…”

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

“…In most instances, this severe condition results in maternal and fetal demise. However, thanks to the enormous advances in life support technologies and critical care management, to date, the progression of pregnancy is possible and a viable newborn can be delivered, despite the increased probability of complications ( 77 ). 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.…”