Pregnancy in a persistent vegetative state: case report, comparison to brain death, and review of the literature.
Severe maternal neurologic injury during pregnancy has the potential for fetal demise without advanced critical care support to the mother. Brain death is the unequivocal and irreversible loss of total brain function, whereas patients in a vegetative state, by contrast, have preserved brain stem function but lack cerebral function. They can appear to be awake, have sleep-wake cycles, be capable of swallowing, and have normal respiratory control, but there are no purposeful interactions. These conditions have different maternal prognoses, but both have resulted in near-normal neonatal outcomes with long latencies from maternal injury to delivery in previously published cases. This article compares and contrasts the 11 cases of brain death with 15 cases of persistent vegetative state in pregnancy. We found that the mean latency between maternal brain injury and delivery was significantly shorter in the brain-dead patients as compared with those in a vegetative state (46 days vs. 124 days, P </=.001). Correspondingly, the gestational ages at delivery (29.7 weeks vs. 33.2 weeks, P </=.01) and the birth weights (1380 g vs. 2145 g, P </=.01) were shorter in duration and smaller in size in the brain-dead group. We also present a case of persistent vegetative state in pregnancy at our institution with both maternal and neonatal death in the context of previously published literature with a focus on obstetric and ethical management. We hope this information will help elucidate the issues for providers confronted with these unique and challenging cases.


BACKGROUND
Obstetricians & Gynecologists, Family Physicians.


OBJECTIVE
After completion of this article, the reader should be able to state the difference between coma, persistent vegetative state and brain death, to describe the neurologic aspects of a patient in a persistent vegetative state, and to list the fetal effects of maternal brain injury.
Bush
Melissa C
MC
Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai School of Medicine, New York, New York 10029, USA. melissacbush@hotmail.com
Nagy
Sandor
S
Berkowitz
Richard L
RL
Gaddipati
Sreedhar
S
D000328:Adult; D001926:Brain Death / Q000503:physiopathology; D004992:Ethics, Medical; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D018458:Persistent Vegetative State / Q000150:complications* / Q000503:physiopathology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology* / Q000503:physiopathology; D011256:Pregnancy Outcome