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