Continuation of pregnancy in a woman with critical brain injury.

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 27th 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 1st, 5th and 10th 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.