Pregnancy and Delivery in a Patient with a Coma

Introduction: Severe brain injury during pregnancy is a potentially dangerous condition for both mother and fetus.

Case report: 25-year old woman admitted to hospital in a critical condition after a road accident with severe traumatic brain injury, multiple limb fractures, traumatic shock, and 4-5 weeks of pregnancy and GCS=5. A decompressive craniotomy was performed. Intermittent positive pressure ventilation was continued for 22 days postoperatively with recovery of spontaneous breathing through a tracheostomy. Her GCS improved to 9. On the 72nd day a diagnosis of post-traumatic vegetative state was given. A multidisciplinary team decided to prolong the pregnancy as close to term, and with according for her relatives wishes. A caesarean section was performed at 36-37 weeks under general anaesthesia. A baby girl was delivered (weight 2 180 gr, height 46 sm, Apgar scores at 1 minute and 5 minutes of 3 and 5 respectively). The patient was discharged home a month after without improvement in neurological state. No abnormalities in the development and health of the child were found, (according to the results of annual surveys performed for the past 6 years).

Discussion: The uniqueness of this case is that the patient spent the entirety of her pregnancy with a GCS 〈 9. Thus a multidisciplinary approach, an individual program of intensive care, the type and extent of brain injury, the maternal and fetal clinical condition, and gestational age should be considered to optimise the treatment and to give to unborn child the best opportunity for survival.