One life ends, another begins: Management of a brain-dead pregnant mother-A systematic review-

Majid Esmaeilzadeh; Christine Dictus; Elham Kayvanpour; Farbod Sedaghat-Hamedani; Michael Eichbaum; Stefan Hofer; Guido Engelmann; Hamidreza Fonouni; Mohammad Golriz; Jan Schmidt; Andreas Unterberg; Arianeb Mehrabi; Rezvan Ahmadi

doi:10.1186/1741-7015-8-74

Table 1 An overview of the reported cases of extended maternal somatic support after brain death (BD) including neonatal outcomes*

From: One life ends, another begins: Management of a brain-dead pregnant mother-A systematic review-

Study	Year/ country	Age of mother (yr)	Cause of BD	Gestational age at BD (wk)	Duration of life support (days)	Maternal medical complications	Indication for delivery	Gestational age at delivery (wk)	Mode of delivery	Neonatal outcome	Organ procurement	Transplant outcome
Dillon et al. [48]	1982/ USA	24	Meningitis	23	24	Thermovariability, DI	Fetal distress	26	C/S	Female, 930 gr, Apgar 8/8, IRDS	No	-
Heikkinen et al. [49]	1985/ Finland	31	ICH SAH	21	71	Thermovariability, pneumonia, hypotension, DI, bacteremia, panhypopituitarism	Maternal blood pressure fluctuation	31	C/S	Male, 1600 gr, Apgar 6/7, IRDS Normal at 8 mo.	No	-
Field et al. [14]	1988/ USA	27	CNS mass	22	63	Thermovariability, hypotension, panhypopituitarism, DI, ARDS, UTI, bacteremia	Septicemia, Growth retardation	31	C/S	Male, 1440 gr Apgar 8/8, IRDS, normal at 18 mo.	No	-
Bernstein et al. [33]	1989/ USA	30	Traumatic brain injury	15	107	Thermovariability, panhypopituitarism, pneumonia, DI	Suspicious for fetal distress	32	C/S	Male, 1555 gr Apgar 6/9, Mild hyperbilirubinemia, Normal at 11 mo.	No	-
Antonini et al. [50]	1992/ Italy	25	ICH	15	49	Panhypopituitarism, Pneumonia UTI, Hemodynamic instability Hyperglycemia anemia	Maternal death due to progressive hypotension	Not applicable	Not applicable	Intrauterine death	No	-
Nettina et al. [51]	1993/ USA	31	ICH	27	44	hypothermia; hypotension; decubitus ulcer, DI, pneumonia	Maternal hypotension	33	C/S	Male, 2083 gr Apgar 9	Yes	N.A.
Anstotz [52]	1993/ Germany	18	Accident	13	38	Severe infection	Not applicable	Not applicable	Not applicable	Spontaneous abortion at 19 weeks (autopsy refused)	No	-
Beguin [53]	1993/ Switzerland	20	ICH	20	3	No complication	Not applicable	Not applicable	Not applicable	Intrauterine death	Yes	N.A.
Wuermeling [54]	1994/ Germany	18	Traffic accident	14	N.A	infection	N.A.	N.A.	N.A.	Intrauterine death	N.A.	-
Iriye et al. [55]	1995/ USA	35	ICH after cocaine	30	2	hypotension	Maternal blood pressure fluctuation	30	C/S	Male, 1610gr, Apgar 7/8	No	-
Vives et al. [56]	1995/ Spain	25	Meningitis	27	1,5	Hypotension, sepsis, DIC, cardiac arrhythmia	Maternal hypotension	27	C/S	Male, 1150 gr, Apgars 7/10, IRDS, normal at 14 mo.	No	-
Catanzarite et al. [32]	1997/ USA	25	ICH	25	25	Hypotension, ARDS, DI, panhypopituitarism, pneumonia,	Fetal distress	28	C/S	Male, 1315 gr Apgar 3/7 fungemia	No	-
Lewis et al. [42]	1997/ USA	20	SAH	25	54	Hypotension, DI bacteremia,	Sufficient fetal lung maturity	32	C/S	Not available	Yes	No complication after 1 year
Suddaby et al. [2]	1998/ USA	Range from 15 to 45 (11 cases)	5 cases: ICH 1 case: Hematoma 1 case: Aneurysm 1 case: Amniotic embolus 1 case: Glioblastoma 1 case: Cardiac arrest 1 case: Gunshot	Range from 2 to 40	N.A	Hypotension DI Anemia Hypernatremia Hyperglycemia Hypocalcemia hyperchloremia	N.A	N.A	N.A	N.A	In five mothers	Of 25 donated organs (5 heart, 5 liver, 10 kidney, 5 pancreas), only one liver and one pancreas graft lost.
Spike [57]	1999/ USA	20	ICH	16	100	Panhypopituitarism, DI, Thermovariability Hypotension	Unusual pattern of the placenta in ultrasound	31	C/S	Male, 1440gr Apgar 8/8	No	-
Beca et al. [58]	1999/ Chile	26	ICH	17	5	Hemodynamic instability Fiber	Maternal death due to resistance hypotension	Not applicable	Not applicable	Intrauterine death	No	-
Lane et al. [59]	2004/ Ireland	26	Cerebral venous sinus thrombosis	13	8	DI, pneumonia, Hyper- and hyponatraemia	Not applicable	Not applicable	Not applicable	Intrauterine death at 14 weeks	Yes	N.A.
Hussein et al. [60]	2006/ UK	33	ICH	26	14	Hypertension, bradycardia, Chest infection, Hyperglycemia, serum cortisol reduced	Progressive oligohydraminos	28	C/S	Male, 1285 gr, breathing difficulties Normal at 24 mo.	No	-
Souza et al. [61]	2006/ Brazil	40	ICH	25	25	Panhypopituitarism, hyperglycemia DI, hypotension, bradycardia, hypothermia, pneumonia,	Progressive oligohydraminos, brain sparring	29	C/S	Male, 815 gr Apgars:9/10 Normal at 3 mo.	Yes	N.A.
Mejia et al. [62]	2008/ Argentina	29	ICH	17	56	DI Panhypopituitarism, Pneumonia UTI, Hemodynamic instability	Maternal hypotension & Cardiac arrest	25	C/S	450 gr Premature Birth complication, Candida infection Died at day 30	No	-

*ICH, intracranial hemorrhage; SAH, subarachnoid hemorrhage; DI, diabetes insipidus; ARDS, acute respiratory distress syndrome; UTI, urinary tract infection; C/S, cesarean section; IRDS, infant respiratory distress syndrome; N.A: not available.

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