Brain death during pregnancy: tocolytic therapy and aggressive maternal support on behalf of the fetus.
We report a case of maternal brain death at 25 weeks gestation in which aggressive maternal hemodynamic, respiratory, and metabolic support and tocolytic drug therapy resulted in prolongation of pregnancy for 25 days. The indication for delivery was torulopsis giabrata amnionitis, which may have occurred due to transmembrane or transplacental route. The baby was treated for fungal sepsis, and did well. Premature labor may occur spontaneously after maternal brain death, and may be precipitated by infection or by maternal drug therapy. The myriad of hemodynamic and endocrine issues associated with maternal brain death complicate the choice of tocolytic drugs, but this case illustrates that uterine activity can be successfully blocked, potentially diminishing risks to the newborn, following the tragedy of maternal brain death during pregnancy.
Catanzarite
V A
VA
Maternal-Fetal Medicine, Sharp Memorial Hospital, San Diego, California, USA.
Willms
D C
DC
Holdy
K E
KE
Gardner
S E
SE
Ludwig
D M
DM
Cousins
L M
LM
D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D001926:Brain Death; D002177:Candidiasis / Q000175:diagnosis / Q000628:therapy; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000628:therapy*; D018572:Disease-Free Survival; D017809:Fatal Outcome; D005260:Female; D016469:Fungemia / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D007752:Obstetric Labor, Premature / Q000209:etiology / Q000517:prevention & control*; D011014:Pneumonia / Q000175:diagnosis / Q000628:therapy*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000628:therapy*; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D015145:Tocolysis / Q000379:methods*
D000666:Amphotericin B