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 | - |