Maternal somatic support after brain death

Maternal somatic support after brain death occurs when a brain dead patient is pregnant and her body is kept alive to deliver a fetus. It occurs very rarely internationally. Even among brain dead patients, in a U.S. study of 252 brain dead patients from 1990–96, only 5 (2.8%) cases involved pregnant women between 15 and 45 years of age.

In the 28-year period between 1982 and 2010, there were "30 [reported] cases of maternal brain death (19 case reports and 1 case series)." In 12 of those cases, a viable child was delivered via cesarean section after extended somatic support. However, according to Esmaelilzadeh, et al. there is no widely accepted protocol to manage a brain dead mother "since only a few reported cases are found in the medical literature." Moreover, the mother's wishes are rarely, if ever, known, and family should be consulted in developing a care plan.

Throughout their care, brain dead patients could experience a wide range of complications, including "infection, hemodynamic instability, diabetes insipidus (DI), panhypopituitarism, poikilothermia, metabolic instability, acute respiratory distress syndrome and disseminated intravascular coagulation." Treating these complications is difficult since the effects of medication on the fetus's health are unknown.

According to Esmaelilzadeh, et al., "[a]t present, it seems that there is no clear lower limit to the gestational age which would restrict the physician's efforts to support the brain dead mother and her fetus." However, the older a fetus is when its mother becomes brain dead, the greater its chance for survival. Research into preterm births indicates that "a fetus born before 24 weeks of gestation has a limited chance of survival. At 24, 28 and 32 weeks, a fetus has approximately a 20-30%, 80% and 98% likelihood of survival with a 40%, 10% and less than 2% chance of suffering from a severe handicap, respectively."

It is important to understand the similarities and differences between brain death and two other conditions: persistent vegetative state and coma.

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