Surrogate Decision Making in the Case of a Pregnant Woman Newly Disabled With Brain Injury

Fins, Joseph J.; Hammond, Christopher J.; Tarsney, Preya S.; Panero, Alberto; Martínez, J. Ros; Kirschner, Kristi L.

doi:10.1016/j.pmrj.2012.12.001

Cited by 1 publication

(2 citation statements)

References 16 publications

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“…14,20,26 Such cases highlight important ethical issues, including prioritization of fetal wellbeing over the potential harms to the mother and the need for maternal surrogate decision making. 27 When interpreting our results, we note that all of the included publications were of low quality with a high likelihood of reporting bias which may provide a biased view of the management and outcomes after maternal neurotrauma. In addition, no nonpregnant control group exists for comparison of management interventions.…”

Section: Discussionmentioning

confidence: 90%

“…Multiple cases focused on aggressive ICP and medical management in the intensive care unit of parturients in a persistent vegetative state to achieve fetal viability and a successful neonatal outcome 14,20,26. Such cases highlight important ethical issues, including prioritization of fetal well-being over the potential harms to the mother and the need for maternal surrogate decision making 27. When interpreting our results, we note that all of the included publications were of low quality with a high likelihood of reporting bias which may provide a biased view of the management and outcomes after maternal neurotrauma.…”

Section: Discussionmentioning

confidence: 99%

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Neurosurgical Interventions for Neurotrauma in the Obstetric Population: A Systematic Review

Kisilevsky

Addison

Flexman

2019

Journal of Neurosurgical Anesthesiology

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Trauma requiring neurosurgical intervention in the obstetric population is rare. Provision of care must include consideration for both maternal and fetal well-being, and conflicts may arise. Management strategies to reduce elevated maternal intracranial pressure (ICP) and provide adequate surgical exposure, for example, may compromise uteroplacental perfusion. There is scarce literature to guide anesthetic care and few resources summarizing management of these uncommon cases. We conducted a systematic literature search for English publications of neurosurgical interventions on obstetric patients following trauma. We searched MEDLINE, EMBASE, and Google Scholar from inception to May 1, 2019. We identified 18 cases from 13 publications including 9 case reports and 4 case series. Median Glasgow coma scale on presentation was 6, good maternal outcome occurred in 39% of cases, and good fetal outcome occurred in 67% of cases. Qualitative review of the articles suggests an initially low Glasgow coma scale on admission commonly resulted in worse maternal and fetal outcomes. Delivery occurred postneurosurgical intervention in the majority of viable fetuses. Few details were available regarding anesthetic management, and ICP management strategies varied widely. Our review identified only a small number of case reports and case series. Maternal outcomes were generally poor, although the majority of fetal outcomes were good. Although there seems to be a relationship between outcomes and severity of maternal injury on presentation, it is difficult to draw conclusions or make recommendations because of limited data on perioperative anesthetic and ICP management strategies. Regardless of gestational age, maternal supremacy must be upheld. Our results are limited by the quality of the available research and potential selection bias.

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