Unique Challenge of Saving Two Lives in Pregnancy with Severe Traumatic Brain Injury: A Narrative Review.

Abstract

A pregnant patient is a body with two lives. Saving the mother and baby after severe head injuries during pregnancy requires intensive monitoring and multidisciplinary team based management. There are many neurosurgical challenges in cases of pregnancy with severe traumatic brain injury (TBI) during pregnancy and the postpartum period due to changes in physiological and anatomical changes due to pregnancy. The strategy to treat post traumatic hydrocephalus using a ventriculoperitoneal shunt is also risky as it tends to malfunction due to a gravid uterus. The challenges and issues faced by the multidisciplinary team of the level I apex trauma center while managing pregnancy complicated by severe TBI and its consequences, like a threat to continue of pregnancy, post traumatic hydrocephalus, anesthesia management if there is requirement of surgery, and perioperative management, are discussed in this review based on available literature. A "one size fits all" approach is slowly being replaced by individualized approaches in children and pregnant women. This is affected by novel diagnostics, advanced monitoring, and multispeciality teams in dedicated trauma centers.