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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2024; 43(03): e179-e186
DOI: 10.1055/s-0041-1733862
Review Article

Traumatic Brain Injury in Pregnancy

Traumatismo cranioencefálico na gravidez
Letícia Adrielle dos Santos 
1   Department of Neurosurgery, Universidade Federal do Sergipe, Aracaju, SE, Brazil
,
Carlos Umberto Pereira 
2   Department of Neurosurgery, Hospital de Urgência do Sergipe, Aracaju, SE, Brazil
,
Maycon Cristian Gomes de Paula 
3   Department of Neurosurgery, Universidade do Vale do Sapucaí, Pouso Alegre, MG, Brazil
,
Gabriela Ferreira Kalkmann 
4   Department of Neurosurgery, Universidade Federal do Paraná, Curitiba, PR, Brazil
,
Nicollas Nunes Rabelo 
5   Department of Neurosurgery, Centro Universitário UniAtenas, Paracatu, MG, Brazil
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Abstract

Objective The present paper aims to provide a review on the main complications involving traumatic brain injury (TBI) during pregnancy and on the vegetative state after TBI.

Methods A systematic review was performed in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria checklist.

Results Seven studies were included, of which four were case reports, one was a follow-up, one was a comparative study, and one was a literature review.

Discussion Presence of neurological deficits such as hemiparesis, neonatal seizures, cerebral palsy, hemorrhage or hydrocephalus was observed in children of mothers who suffered trauma during pregnancy. The prolongation of a pregnancy in these victims, even in brain death, is within the reach of current medicine. Ethical issues must be considered when deciding to prolong a pregnancy of a woman in brain death.

Conclusion For the evaluation of pregnant women with TBI, there is a protocol that can be followed in the emergency care service. The cases reported in the literature suggest that there is no clear limit to restrict support to a pregnant patient in a vegetative state. Further studies should be done to elucidate this matter.

Resumo

Objetivo O presente artigo buscou revisar as principais complicações envolvendo lesão cerebral traumática durante a gravidez e sobre estado vegetativo após esse trauma.

Métodos Uma revisão sistemática foi realizada de acordo com o checklist dos critérios Principais itens para relatar Revisões sistemáticas e Metanálises (PRISMA, na sigla em inglês).

Resultados Sete estudos foram incluídos, dos quais quatro eram relatos de caso, um era um acompanhamento, um era um estudo comparativo, e um era uma revisão de literatura.

Discussão Presença de déficit neurológico como hemiparesias, convulsões neonatais, paralisia cerebral, hemorragia e hidrocefalia foram observadas em crianças cuja mãe sofreu trauma durante a gravidez. O prolongamento da gravidez nessas vítimas, mesmo nos casos de morte cerebral, está ao alcance da medicina atual. Dilemas éticos devem ser considerados na decisão de prolongar a gravidez em mulheres com trauma cerebral.

Conclusão Para avaliação de grávidas com trauma cerebral, existe um protocolo que pode ser seguido em serviços de emergência. Os casos relatados na literatura sugerem que não há um limite claro para restringir o suporte a uma paciente grávida em estado vegetativo. Mais estudos devem ser realizados para elucidar a questão.

Keywords

traumatic brain injury - pregnancy - management - developmental disabilities - persistent vegetative state

Palavras-chave

traumatismo cranioencefálico - gravidez - gestão - deficiências de desenvolvimento - estado vegetativo persistente


Publication History

Received: 01 August 2020

Accepted: 09 March 2021

Article published online:
07 February 2022

© 2022. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Shah KH, Simons RK, Holbrook T, Fortlage D, Winchell RJ, Hoyt DB. Trauma in pregnancy: maternal and fetal outcomes. J Trauma 1998; 45 (01) 83-86
    CrossrefPubMedGoogle Scholar
  • 2 Leroy-Malherbe V, Bonnier C, Papiernik E, Groos E, Landrieu P. The association between developmental handicaps and traumatic brain injury during pregnancy: an issue that deserves more systematic evaluation. Brain Inj 2006; 20 (13-14): 1355-1365
    CrossrefPubMedGoogle Scholar
  • 3 Gilles MT, Blair E, Watson L. et al. Trauma in pregnancy and cerebral palsy: is there a link?. Med J Aust 1996; 164 (08) 500-501
    CrossrefPubMedGoogle Scholar
  • 4 Patterson RM. Trauma in pregnancy. Clin Obstet Gynecol 1984; 27 (01) 32-38
    CrossrefPubMedGoogle Scholar
  • 5 Sim KB. Maternal persistent vegetative state with successful fetal outcome. J Korean Med Sci 2001; 16 (05) 669-672
    CrossrefPubMedGoogle Scholar
  • 6 Ali J, Yeo A, Gana TJ, McLellan BA. Predictors of fetal mortality in pregnant trauma patients. J Trauma 1997; 42 (05) 782-785
    CrossrefPubMedGoogle Scholar
  • 7 Peckham CH, King RW. A study of intercurrent conditions observed during pregnancy. Am J Obstet Gynecol 1963; 87 (05) 609-624
    CrossrefPubMedGoogle Scholar
  • 8 Baethmann M, Kahn T, Lenard HG, Voit T. Fetal CNS damage after exposure to maternal trauma during pregnancy. Acta Paediatr 1996; 85 (11) 1331-1338
    CrossrefPubMedGoogle Scholar
  • 9 Yamamoto T, Koeda T, Ishii S, Takeshita K. A patient with cerebral palsy whose mother had a traffic accident during pregnancy: a diffuse axonal injury?. Brain Dev 1999; 21 (05) 334-336
    CrossrefPubMedGoogle Scholar
  • 10 El-Kady D, Gilbert WM, Anderson J, Danielsen B, Towner D, Smith LH. Trauma during pregnancy: an analysis of maternal and fetal outcomes in a large population. Am J Obstet Gynecol 2004; 190 (06) 1661-1668
    CrossrefPubMedGoogle Scholar
  • 11 Murphy NJ, Quinlan JD. Trauma in pregnancy: assessment, management, and prevention. Am Fam Physician 2014; 90 (10) 717-722
    PubMedGoogle Scholar
  • 12 Farmer DL, Adzick NS, Crombleholme WR, Crombleholme TM, Longaker MT, Harrison MR. Fetal trauma: relation to maternal injury. J Pediatr Surg 1990; 25 (07) 711-714
    CrossrefPubMedGoogle Scholar
  • 13 Goodwin TM, Breen MT. Pregnancy outcome and fetomaternal hemorrhage after noncatastrophic trauma. Am J Obstet Gynecol 1990; 162 (03) 665-671
    CrossrefPubMedGoogle Scholar
  • 14 Pearlman MD, Tintinalli JE. Evaluation and treatment of the gravida and fetus following trauma during pregnancy. Obstet Gynecol Clin North Am 1991; 18 (02) 371-381
    CrossrefPubMedGoogle Scholar
  • 15 Connolly AM, Katz VL, Bash KL, McMahon MJ, Hansen WF. Trauma and pregnancy. Am J Perinatol 1997; 14 (06) 331-336
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Ben AderetN. et al. Traumatic coma during pregnancy with persistent vegetative state. Case report. British Journal of Obstetrics and Gynaecology 1984; 91 (01) 939-941 DOI: 10.1111/j.1471-0528.1984.tb03713.x.
    CrossrefPubMedGoogle Scholar
  • 17 Bernstein IM, Watson M, Simmons GM, Catalano PM, Davis G, Collins R. Maternal brain death and prolonged fetal survival. Obstet Gynecol 1989; 74 (3 Pt 2): 434-437
    PubMedGoogle Scholar
  • 18 Kho GS, Abdullah JM. Management of severe traumatic brain injury in pregnancy: A body with two lives. Malays J Med Sci 2018; 25 (05) 151-157
    CrossrefPubMedGoogle Scholar
  • 19 Suddaby EC, Schaeffer MJ, Brigham LE, Shaver TR. Analysis of organ donors in the peripartum period. J Transpl Coord 1998; 8 (01) 35-39
    PubMedGoogle Scholar
  • 20 Esmaeilzadeh M. et al. One life ends, another begins: Management of a brain-dead pregnant mother-A systematic review-. BMC Medicine 2010; 8: 74 DOI: 10.1186/1741-7015-8-74.
    CrossrefPubMedGoogle Scholar
  • 21 Berry C, Ley EJ, Mirocha J, Margulies DR, Tillou A, Salim A. Do pregnant women have improved outcomes after traumatic brain injury?. Am J Surg 2011; 201 (04) 429-432
    CrossrefPubMedGoogle Scholar
  • 22 Dawar P. et al. Decompressive craniectomy in term pregnancy with combined caesarean section for traumatic brain injury. Neurology India 2013; 61 (04) 423-425 DOI: 10.4103/0028-3886.117588.
    CrossrefPubMedGoogle Scholar
  • 23 Tawfik MM, Badran BA, Eisa AA, Barakat RI. Simultaneous cesarean delivery and craniotomy in a term pregnant patient with traumatic brain injury. Saudi J Anaesth 2015; 9 (02) 207-210
    CrossrefPubMedGoogle Scholar
  • 24 Inoue A, Ebina M, Atsumi T, Ariyoshi K. Refractory paroxysmal sympathetic hyperactivity following brain injury in a pregnant woman that dramatically improved after delivery. Acute Med Surg 2015; 3 (03) 268-271
    CrossrefPubMedGoogle Scholar
  • 25 Slattery MM, Morrison JJ. Preterm delivery. Lancet 2002; 360 (9344) 1489-1497
    CrossrefPubMedGoogle Scholar
  • 26 Luke B. Nutritional influences on fetal growth. Clin Obstet Gynecol 1994; 37 (03) 538-549
    CrossrefPubMedGoogle Scholar
  • 27 Bhatia P, Bhatia K. Pregnancy and the lungs. Postgrad Med J 2000; 76 (901) 683-689
    CrossrefPubMedGoogle Scholar
  • 28 Milliez J, Cayol V. Palliative care with pregnant women. Best Pract Res Clin Obstet Gynaecol 2001; 15 (02) 323-331
    CrossrefPubMedGoogle Scholar
  • 29 Dominguez-Roldan JM, Murillo-Cabezas F, Santamaria-Mifsut JL, Muñoz-Sanchez A, Villen-Nieto J, Barrera-Chacon JM. Changes in resting energy expenditure after development of brain death. Transplant Proc 1995; 27 (04) 2397-2398
    PubMedGoogle Scholar
  • 30 Villa-Forte Gomes MP. Venous thromboembolism in pregnancy. Curr Treat Options Cardiovasc Med 2009; 11 (02) 104-113
    CrossrefPubMedGoogle Scholar
  • 31 Farragher RA, Laffey JG. Maternal brain death and somatic support. Neurocrit Care 2005; 3 (02) 99-106
    CrossrefPubMedGoogle Scholar
  • 32 Korzeniowski OM. Antibacterial agents in pregnancy. Infect Dis Clin North Am 1995; 9 (03) 639-651
    CrossrefPubMedGoogle Scholar
  • 33 Einarson A, Shuhaiber S, Koren G. Effects of antibacterials on the unborn child: what is known and how should this influence prescribing. Paediatr Drugs 2001; 3 (11) 803-816
    CrossrefPubMedGoogle Scholar
  • 34 Christensen B. Which antibiotics are appropriate for treating bacteriuria in pregnancy?. The Journal of Antimicrobial Chemotherapy 2000; 46 (Suppl. 01) 29-34 . Discussion 63–65
    CrossrefPubMedGoogle Scholar
  • 35 van Runnard Heimel PJ, Franx A, Schobben AFAM, Huisjes AJM, Derks JB, Bruinse HW. Corticosteroids, pregnancy, and HELLP syndrome: a review. Obstet Gynecol Surv 2005; 60 (01) 57-70 , quiz 73–74
    CrossrefPubMedGoogle Scholar