(647) To Be or Not To Be: The Case of Life-Threatening Intracranial Hemorrhage in a 17-Week Pregnant Woman

Introduction: We present one of the first critical care reports of a pregnant patient in a persistent vegetative state since Roe v. Wade was reversed. The family was considering withdrawal of care, however this was not an option due to state law.

Description: A 37-year-old woman was admitted to ICU with pontine hemorrhage and incidentally discovered to be 17 weeks pregnant. Despite aggressive management, including blood pressure control, EVD placement, and mechanical ventilation, the patient remained comatose. The family was considering withdrawal of care, however due to state law, this was not an option. The fetus was noted to have low heart rate, so the patient was transferred to a hospital with both neurocritical care and OB capabilities. The patient was managed in the neurocritical care unit for 8 weeks, until the patient began having contractions. These were conservatively managed at first, however the patient progressed to labor, and the patient ultimately required emergent bedside C-section in the neurocritical care unit. The patient remains in a vegetative state and the baby remains in the neonatal intensive care unit.

Discussion: The reversal of Roe v. Wade changed how critically ill pregnant patients are managed. Immanual Kant described humanity as always treating a person as an end, not as a means. This concept is challenged when state law prevents removal of life support in a patient with no expectation of meaningful (ability to interact with their environment) recovery for the sole purpose of incubating a fetus.

Additional considerations include poor anticipated viability of the surviving fetus. Though limited data exists, a 2010 study evaluated 30 brain dead pregnant women with a mean pregnancy of 22 weeks. With total care, the mean delivery was 29.5 weeks and only 12 viable neonates born and surviving past the neonatal period.1 The anticipated one-year fetal survival is approximately 56% if 24 weeks of pregnancy is reached.2 Significant strain is placed on family with both mother and child critically ill. This is also distressing for healthcare staff to witness and participate in.

Critical care providers need to be well-versed on state abortion laws, exceptions, and be prepared to discuss the legal and ethical considerations with families and healthcare workers.