One Hundred and Fourteen Days of Somatic Support in a Severely Brain Injured Pregnant Woman: Case Report and Review of the Literature

Abstract

The management of a previable pregnancy complicated by severe brain injury raises the question of whether to provide somatic support in order to maintain the pregnancy or not. Obstetricians who encounter this clinical scenario are faced with emotional, medical and ethical complexities, which require multidisciplinary input. A 19-year-old woman with an unremarkable medical history suffered severe brain injury and remained in a persistent vegetative state following a gunshot wound to the neck. She was discovered to be 15 weeks pregnant during resuscitative efforts. Following consultation with her family and power of attorney it was agreed to continue somatic support in order to maintain the pregnancy. A literature review to determine the best evidence based care from a multidisciplinary perspective is performed addressing issues of ethics, simulation and management of changes in maternal physiology, as well as pregnancy outcomes based on the neurological sequelae following severe brain injury. Previable pregnancies complicated by severe brain injury may be maintained until viability. Based on limited data, the obstetric outcomes may differ depending on whether the neurological sequelae are brain death or a persistent vegetative state. This management should be performed following consultation with the patient's power of attorney in conjunction with the ethics committee and legal department of the hospital. Maternal physiological changes of pregnancy must be considered for successful somatic support.