Utrzymanie ciąży u ciężarnej z krytycznym uszkodzeniem mózgu

Abstract

Background: Critical brain injury can lead to brain death, which is medically and legally considered the death of an individual. Further therapy is discontinued, unless organ donation is possible or brain death occurs in a pregnant woman. Case report: A 30-year old woman at 22 weeks gestation developed a subarachnoid haemorrhage from a ruptured cerebral artery aneurysm. The patient was admitted to the Intensive Care Unit in critical condition. On treatment day 3, the symptoms of brain death occurred. Due to possible complications, the apnoea test and instrumental examinations were not performed. Therapy maintaining vital functions was carried out in order to sustain the pregnancy. The patient was ventilated, received cardiac-supportive drugs, hormone replacement therapy, enteral and parenteral feedings and systemic infections were treated as well. At the beginning of the 27 th week of gestation, massive bleeding from the airways developed. A Caesarean section was performed, and a female neonate was born, birth weight 680 g, the Apgar scores 4, 6 and 6 at 1 st , 5 th and 10 th minute, respectively. After 3.5 months, the baby was discharged from the Neonatal Intensive Care Unit. Her development at the age of 8 months is normal. Conclusions: The case described and similar cases reported in the literature demonstrate that the maternal brain death is an interdisciplinary medical challenge. Thanks to intensive care techniques, maternal somatic functions can be maintained, and a healthy child can be delivered.

Status of Baby Born to Brain-dead Mother: Ethical and Logical Issues

“…There is no global register of such patients, and literature provides information on thirty-seven cases registered between 1982 and 2019. Cases of brain death in pregnant women have been reported in the United States, Finland, Italy, Germany, Switzerland, Spain, Chile, Ireland, Great Britain, Brazil, Argentina, Poland, the United Arab Emirates, Croatia, and Japan (Bush et al, 2003;Burkle et al, 2003;Esmaeilzadeh et al, 2010;Heikkinen et al, 1985;Hussein et al, 2016;Lane et al, 2004;Nishimura et al, 2016;Souza et al, 2006;Wawrzyniak et al, 2015;Woderska et al, 2012;Said, et al, 2013;Wróżyńska, 2019). It is suspected that a large number of case reports have not been published due to therapeutic failure or that no diagnosis of brain death was made due to the inability to perform full diagnostics (e.g.…”

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

“…There is another, exceptionally rare and not well-defined exception, and that is when the patient is a pregnant woman, and consequently, the life of a foetus is directly dependent on maintaining the mother’s biological functions. Lacking any clear legal instructions or medical guidelines, based on the available medical literature, it seems that maintaining the mother’s life functions [2, 3, 4] to attempt to save a child can be both medically and ethically justifiable [5, 6, 7, 8].…”