Management of the Pregnant Woman Who Sustains Severe Brain Damage

Abstract

Management of the severely brain-injured pregnant patient is a considerable challenge to the ethicist as well as to the obstetrician; to the neurologist; and, of course, to any family on which such a tragedy might fall. Certainly, it is ethical in some situations to continue somatic support of a lethally injured gravida for the benefit of the fetus. It is equally ethical in certain situations to withdraw support of a severely neurologically compromised patient regardless of an ongoing pregnancy. Physicians caring for such a patient must clarify the maternal diagnosis, the fetal gestational age, and the prognosis of both maternal and fetal patients. The appropriate proxy decision maker for the patient incapable of giving informed consent must be identified, and extensive effort must be expended to educate and empathize with that individual as well as any other involved family members. Application of the basic principles of medical ethics can then provide a framework within which the above information can be used to develop and evolve an appropriate clinical management plan for the specific situation at hand.