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Maternal somatic support after brain death
Maternal somatic support after brain death occurs when a brain dead patient is pregnant and her body is kept alive to deliver a fetus. It occurs very rarely internationally. Even among brain dead patients, in a U.S. study of 252 brain dead patients from 1990–96, only 5 (2.8%) cases involved pregnant women between 15 and 45 years of age.
In the 28-year period between 1982 and 2010, there were "30 [reported] cases of maternal brain death (19 case reports and 1 case series)." In 12 of those cases, a viable child was delivered via cesarean section after extended somatic support. However, according to Esmaelilzadeh, et al. there is no widely accepted protocol to manage a brain dead mother "since only a few reported cases are found in the medical literature." Moreover, the mother's wishes are rarely, if ever, known, and family should be consulted in developing a care plan.
Throughout their care, brain dead patients could experience a wide range of complications, including "infection, hemodynamic instability, diabetes insipidus (DI), panhypopituitarism, poikilothermia, metabolic instability, acute respiratory distress syndrome and disseminated intravascular coagulation." Treating these complications is difficult since the effects of medication on the fetus's health are unknown.
According to Esmaelilzadeh, et al., "[a]t present, it seems that there is no clear lower limit to the gestational age which would restrict the physician's efforts to support the brain dead mother and her fetus." However, it is likely that the older a fetus is when its mother becomes brain dead, the greater its chance for survival, since survival odds in cases of preterm birth improve with increasing gestational age.
It is important to understand the similarities and differences between brain death and two other conditions: persistent vegetative state and coma.
Patients in a persistent vegetative state "are alive but also have severely impaired consciousness, although their eyes may open spontaneously. The eye opening may give the impression of consciousness, but there is no awareness of the environment. These patients do not acknowledge the examiner; they do not attend or track objects that are presented to them; their movements are non-purposeful; they do not speak." The difference between the two states is that brain death means "death of the brainstem" which can be clinically diagnosed and vegetative state means "permanent and total loss of forebrain function" which needs further investigation.
People in comas have "presence of brain stem responses, spontaneous breathing or non-purposeful motor responses." However, comas can result in brain death, or recovery or even a persistent vegetative state.
Several laws have bearing in situations that involve maternal somatic support after brain death. The Federal Patient Self-Determination Act (PSDA) requires health care institutions to provide newly admitted adult patients with information regarding advance health care directives. The intent of this law is to make patients aware of their rights with regard to end-of-life care.
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Maternal somatic support after brain death
Maternal somatic support after brain death occurs when a brain dead patient is pregnant and her body is kept alive to deliver a fetus. It occurs very rarely internationally. Even among brain dead patients, in a U.S. study of 252 brain dead patients from 1990–96, only 5 (2.8%) cases involved pregnant women between 15 and 45 years of age.
In the 28-year period between 1982 and 2010, there were "30 [reported] cases of maternal brain death (19 case reports and 1 case series)." In 12 of those cases, a viable child was delivered via cesarean section after extended somatic support. However, according to Esmaelilzadeh, et al. there is no widely accepted protocol to manage a brain dead mother "since only a few reported cases are found in the medical literature." Moreover, the mother's wishes are rarely, if ever, known, and family should be consulted in developing a care plan.
Throughout their care, brain dead patients could experience a wide range of complications, including "infection, hemodynamic instability, diabetes insipidus (DI), panhypopituitarism, poikilothermia, metabolic instability, acute respiratory distress syndrome and disseminated intravascular coagulation." Treating these complications is difficult since the effects of medication on the fetus's health are unknown.
According to Esmaelilzadeh, et al., "[a]t present, it seems that there is no clear lower limit to the gestational age which would restrict the physician's efforts to support the brain dead mother and her fetus." However, it is likely that the older a fetus is when its mother becomes brain dead, the greater its chance for survival, since survival odds in cases of preterm birth improve with increasing gestational age.
It is important to understand the similarities and differences between brain death and two other conditions: persistent vegetative state and coma.
Patients in a persistent vegetative state "are alive but also have severely impaired consciousness, although their eyes may open spontaneously. The eye opening may give the impression of consciousness, but there is no awareness of the environment. These patients do not acknowledge the examiner; they do not attend or track objects that are presented to them; their movements are non-purposeful; they do not speak." The difference between the two states is that brain death means "death of the brainstem" which can be clinically diagnosed and vegetative state means "permanent and total loss of forebrain function" which needs further investigation.
People in comas have "presence of brain stem responses, spontaneous breathing or non-purposeful motor responses." However, comas can result in brain death, or recovery or even a persistent vegetative state.
Several laws have bearing in situations that involve maternal somatic support after brain death. The Federal Patient Self-Determination Act (PSDA) requires health care institutions to provide newly admitted adult patients with information regarding advance health care directives. The intent of this law is to make patients aware of their rights with regard to end-of-life care.