Clinicaly dead pregnant woman on life support

conorh91

ProfessorPlum wrote: »

There are a total of 2 cases in the medical literature where a foetus of a similar gestation or earlier survived to term. 2. In total. The usual outcome is not to survive.

eh no, see my above post.

ProfessorPlum

conorh91 wrote: »

eh no, see my above post.

Read the abstract again. Not the same senario. Do you have the article in its entirety and we might be better able to draw a conclusion.

conorh91

ProfessorPlum wrote: »

Read the abstract again. Not the same senario. Do you have the article in its entirety and we might be better able to draw a conclusion.

Of course I've read the article and that's why I'm linking it.

I'm not going to breach copyright and the site rules by posting the whole thing here, if you cannot access it.

On what basis are you claiming the situations described in that review article are materially different to the present case?

NZ_2014

My name is URL wrote: »

That's a stupid argument to say the least.

There's a big shortage of young people in many countries around the world, Ireland included.

It's almost at crisis point in terms of aging populations in a lot of places.

My name is URL wrote: »

Population aging, Sub-replacement fertility and increased dependency ratios are serious problems that most of the developed world is facing.

A shortage of young people, or an oversupply of older people? The population has increased from about two billion to seven billion over the last 114 years since 1900, I was going to rabbit on about the effects of this but I won't.

Neither here nor there in terms of this topic, a sad situation.

My name is URL

conorh91 wrote: »

I'm not going to breach copyright and the site rules by posting the whole thing here, if you cannot access it.

The full article is available on ResearchGate

http://www.researchgate.net/profile/John_Rodis/publication/12251431_Irreversible_maternal_brain_injury_during_pregnancy_a_case_report_and_review_of_the_literature/links/00b7d51e052dd7a1ae000000.pdf

ProfessorPlum

conorh91 wrote: »

Of course I've read the article and that's why I'm linking it.

I'm not going to breach copyright and the site rules by posting the whole thing here, if you cannot access it.

On what basis are you claiming the situations described in that review article are materially different to the present case?

Here's a more recent case report and review of brain stem death and pregnancy. The outcome seems to be significantly different to PVS.

http://www.ncbi.nlm.nih.gov/pmc/arti...C3883204/#ref1

"According to the reported cases in the medical literature,[1] this is the second reported case where prolonged somatic support led to the delivery of a viable child in which the fetus was about 16 weeks of gestation"

"There are 30 cases reported in the literature between 1982 and 2010 on brain-dead pregnant women whose somatic non-neurological functions were maintained successfully to facilitate fetal maturation in the uterus. However, of the cases reported, 12 viable infants were born and survived the neonatal period."

My name is URL

ProfessorPlum wrote: »

However, of the cases reported, 12 viable infants were born and survived the neonatal period."[/I]

So, somewhat better than a 'snowballs chance in hell' as many have been claiming

conorh91

ProfessorPlum wrote: »

Here's a more recent case report and review of brain stem death and pregnancy. The outcome seems to be significantly different to PVS.

In the paper I linked to, 8 of the healthy babies born were born to mothers who had suffered brain-stem death. Only two were PVS, and it isn't clear why there should be a substantial difference anyway.

"According to the reported cases in the medical literature,[1] this is the second reported case where prolonged somatic support led to the delivery of a viable child in which the fetus was about 16 weeks of gestation"

So this is where you're getting the claim that there are only two? Read the above again. It reads to me as the second in which the foetus was about 16 weeks. Not the second ever.

In my link, there were healthy babies born, who were foetuses who were 6, 15, 15 and 18 weeks at the time of maternal brain injury.

"There are 30 cases reported in the literature between 1982 and 2010 on brain-dead pregnant women whose somatic non-neurological functions were maintained successfully to facilitate fetal maturation in the uterus. However, of the cases reported, 12 viable infants were born and survived the neonatal period."

That's a success rate of 2 in 5.

It's hardly a snowball's chance in Hell.

That time line excludes some of the successful births I linked to. Any such exclusions tend to have a dramatic effect on the aggregate rate, so that should also be borne in mind.

Nothing you have provided here has suggested that the baby has no hope. Many families on ICU wards tonight would be jumping for joy if their loved one's were given as much as a 40% chance of a healthy recovery.

ProfessorPlum

My name is URL wrote: »

So, somewhat better than a 'snowballs chance in hell' as many have been claiming

Those 12 cases are in the majority cases where the foetus was much more mature and already viable - in other words, ready or almost ready to be born.
The outlook is much more pessimistic for very immature foeti who would require prolonged support before birth.

conorh91

ProfessorPlum wrote: »

Those 12 cases are in the majority cases where the foetus was much more mature and already viable - in other words, ready or almost ready to be born.
The outlook is much more pessimistic for very immature foeti who would require prolonged support before birth.

I'd like to check that, because it isn't reflected in the study I provided, where very-early gestational injuries resulted in healthy babies.

Do you have a link that works?

Your above link doesn't work.

ProfessorPlum

conorh91 wrote: »

In the paper I linked to, 8 of the healthy babies born were born to mothers who had suffered brain-stem death. Only two were PVS, and it isn't clear why there should be a substantial difference anyway.

So this is where you're getting the claim that there are only two? Read the above again. It reads to me as the second in which the foetus was about 16 weeks. Not the second ever.

In my link, there were healthy babies born, who were foetuses who were 6, 15, 15 and 18 weeks at the time of maternal brain injury.

That's a success rate of 2 in 5.

It's hardly a snowball's chance in Hell.

That time line excludes some of the successful births I linked to. Any such exclusions tend to have a dramatic effect on the aggregate rate, so that should also be borne in mind.

Nothing you have provided here has suggested that the baby has no hope. Many families on ICU wards tonight would be jumping for joy if their loved one's were given as much as a 40% chance of a healthy recovery.

No, I agree. Not no hope. Very little hope though., and nowhere near 40%.

There's huge difference between a 17 week foetus and a 27 week one. How many foeti who were less than 17 weeks gestation (it seems that the current case has been maintained since it was about 15 weeks) and the mother was brain dead had a positive outcome?


http://www.independent.ie/irish-news/health/clinically-dead-pregnant-woman-being-kept-alive-by-hospital-30845660.html

“The legal advice would be there is one life here and it is the unborn child. Everything practicable has to be done – and that’s both under the constitution and the legislation passed last year. There is also a high possibility the unborn child will not survive,” a senior source said last night.

BarneyThomas

conorh91 wrote: »

Ok now I'm really skeptical about earlier claims that a foetus has a snowball's chance in Hell of reaching viability in circumstances where the brain-dead mother is maintained on life-support during the pregnancy.

This paper cites foetuses between the gestational ages of 6 weeks and 27 weeks who were maintained in-utero and later delivered following irreversible brain injury to the mother.
ncbi.nlm.nih.gov/pubmed/11075735

None of the 11 foetuses were reported as suffering from major developmental problems. Others are reported as being "alive and well" after birth.

The most adverse neonatal outcome was that one child had to stay in hospital for two months after birth, but that's probably because he was delivered at 27 weeks.

I previously in this thread cited another study where a 15-week-old foetus was maintained in the uterus of his brain-dead mother until birth, and was reported as being alive and well after birth.

Im a doctor and to be honest i couldnt even find out the amount of cases of this nature.
Suffice to say that there have been cases, and medical practice is improving the odds of survival all the time. There will be experts involved, who have seen this before and who know what they are doing. They will have seen this type of action fail many times i would think, but will have also seen success.

Anyone coming on and telling you what the chances of survival actually are in this situation right now is just lying, no matter how many links they trawl the internet to get to show their "expertise".
Basically if the fetus can get to the stage where the lungs are developed sufficiently the odds increase by a massive factor.
Every other fetus has to get to that stage anyway, be it in a healthy mother or an unhealthy mother. About 25% (a little higher than that actually) or so of pregnancies do not make it.
After 12 weeks theres a huge jump in the chances of making it all the way.

What the effect of the mother not being alive is on the fetus is unknown.

Medically there is a possibility of a healthy child being born at the end of this. they would probably deliver the baby at about 30 weeks give or take if there is any danger at that point, but thats up to the doctors involved and nobody but nobody can tell you any better than they can what the chances are and what the best course of action is.

You dont get pregnancies being aborted by doctors at 6 weeks because they only have a 75% chance of surviving all the way to birth. This case is no different.

To sum up, in any particular situation i couldnt tell you if you were pregnant whether you are going to go all the way, even now. So I certainly couldnt tell you what the chances of the pregnancy in question has of going far enough for the child to survive.

What we do is we assume that the pregnancy is going to be successful unless we find out otherwise. There should be no difference here.

My name is URL

ProfessorPlum wrote: »

Those 12 cases are in the majority cases where the foetus was much more mature and already viable - in other words, ready or almost ready to be born.
The outlook is much more pessimistic for very immature foeti who would require prolonged support before birth.

Is it known whether the fetus in this case suffered from the event that the mother succumbed to? That's likely a far greater indicator of whether or not it will become a viable birth later on, presuming any life support complications are dealt with accordingly.

ProfessorPlum

conorh91 wrote: »

I'd like to check that, because it isn't reflected in the study I provided, where very-early gestational injuries resulted in healthy babies.

Do you have a link that works?

Your above link doesn't work.

Sorry - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3883204/#ref1

conorh91

ProfessorPlum wrote: »

There's huge difference between a 17 week foetus and a 27 week one. How many foeti who were less than 17 weeks gestation and the mother was brain dead had a positive outcome?

In the review study I linked to, as regards maternal brain deaths, the earliest maternal injury occurred at 15 weeks gestation. A baby was later reported as being healthy and well after delivery. There were obviously later cases too, but that was the earliest.

Again. I don't see any evidence that there should be expected to be a material difference in outcomes between cases of maternal brain-stem death vs alternative brain injury, inlcuding PVS.

conorh91

ProfessorPlum wrote: »

Sorry - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3883204/#ref1

ok.. from your own link...

Based on previous reports, the gestational age of the fetus was important in deciding to attempt somatic support following brain death.[2] However, this is no longer an important issue especially with the important advances in life-support technology and critical care that enables the maintenance of vital functions.

bogwalrus

BarneyThomas wrote: »

Im a docor

It would be good to know a doctor is involved in this discussion but could you provide some proof. You should not be afraid to disclose some proof as it really would help in a productive debate.

ProfessorPlum

My name is URL wrote: »

Is it known whether the fetus in this case suffered from the event that the mother succumbed to? That's likely a far greater indicator of whether or not it will become a viable birth later on, presuming any life support complications are dealt with accordingly.

No, I don't believe there is any information in the public domain about that. Pregnancy is a much more complicated state to support. It is not just a matter of keeping the woman's body oxygenated and perfused.

BarneyThomas

bogwalrus wrote: »

It would be good to know a doctor is involved in this discussion but could you provide some proof. You should not be afraid to disclose some proof as it really would help in a productive debate.

Me being a doctor has nothing to do with what I know about the situation.
You should ignore that i said it completely.
I only mentioned it for the fact that i cant find out things either, with the resources i have available to me. And to point out that to say any specific % chances, never mind "a snowballs chance in hell" is just utter nonsense.

I know nothing of what is happening here, but that noone else here knows either.

All I know is it is in the hands of experts who do know what they are doing and have done this before. they will all be communicating with the doctors on site constantly.
They are the ones who ultimately will save this pregnancy.

I dont think its unreasonable to give this situation 10 weeks before making any decisions on whether the pregnancy will survive or not. Thats my point.

ProfessorPlum

conorh91 wrote: »

ok.. from your own link...

Based on previous reports, the gestational age of the fetus was important in deciding to attempt somatic support following brain death.[2] However, this is no longer an important issue especially with the important advances in life-support technology and critical care that enables the maintenance of vital functions.

That is a statement that it is possible to attempt somatic support - not an indication of the likelihood of positive outcome.
A senior source involved in the case, and I would presume would have more information, gave a high probability that the child would not survive.

“The legal advice would be there is one life here and it is the unborn child. Everything practicable has to be done – and that’s both under the constitution and the legislation passed last year. There is also a high possibility the unborn child will not survive,” a senior source said last night.

BarneyThomas

bogwalrus wrote: »

It would be good to know a doctor is involved in this discussion but could you provide some proof. You should not be afraid to disclose some proof as it really would help in a productive debate.

Me being a doctor has nothing to do with what I know about the situation.
You should ignore that i said it completely.
I only mentioned it for the fact that i cant find out things either, with the resources i have available to me. And to point out that to say any specific % chances, never mind "a snowballs chance in hell" is just utter nonsense.

I know nothing of what is happening here, but that noone else here knows either.

All I know is it is in the hands of experts who do know what they are doing and have done this before. they will all be communicating with the doctors on site constantly.
They are the ones who ultimately will save this pregnancy.

I dont think its unreasonable to give this situation 10 weeks before making any decisions on whether the pregnancy will survive or not. Thats my point.

Even the experts involved here will come out of this with far more knowledge and experience that will measurably increase the likelihood of the next surviving.

This fetus should be given that chance. Medical research will benefit too, no matter what the outcome. And if a child is born it will have been worth it, and that, nobody can deny.

conorh91

ProfessorPlum wrote: »

That is a statement that it is possible to attempt somatic support - not an indication of the likelihood of positive outcome.

But those pregnant mothers are brain dead! Somatic support is being maintained for one reason only - to deliver a viable child. If the report says that gestational age of the fetus is no longer important, it is obviously referring to the likelihood of a live delivery.

Really, you are preferring the comments of an anonymous Indo source who might have been a lawyer for all we know? Instead of a peer-reviewed journal article which appears to suggest that gestational age at maternal injury is "no longer an important issue"?

We have clear evidence of healthy children being born after maternal brain death, some of those maternal brain deaths were as early as 15 weeks gestation. I really don't know how long you can keep this up for.

BarneyThomas

ProfessorPlum. Let me ask you this

Do you seriously think that there is a "snowballs chance in hell" of a child being born here.

If not,
what do you think the chances are of a child being born? And how did you come to that conclusion?

And if there is a chance, do you think it would be reasonable to wait another 10 weeks and then lets the experts on the scene decide what the chances are?

ProfessorPlum

conorh91 wrote: »

But those pregnant mothers are brain dead! Somatic support is being maintained for one reason only - to deliver a viable child. If the report says that gestational age of the fetus is no longer important, it is obviously referring to the likelihood of a live delivery.

Really, you are preferring the comments of an anonymous Indo source who might have been a lawyer for all we know? Instead of a peer-reviewed journal article which appears to suggest that gestational age at maternal injury is "no longer an important issue"?

We have clear evidence of healthy children being born after maternal brain death, some of those maternal brain deaths were as early as 15 weeks gestation. I really don't know how long you can keep this up for.

No, I'm not preferring an anonymous source, merrily pointing out a source that I have no reason not to believe, and one it seems that has more access to actual information about this particular case. I'm surprised that you would deduce from my statement that I preferred it. How odd for a legal professional.

The journal article is hardly 'obviously referring to the likelihood of a live delivery" given that the authors could only find 2 cases of live birth after maternal brain death at or before a similar point to the present case under discussion.

ProfessorPlum

BarneyThomas wrote: »

ProfessorPlum. Let me ask you this

Do you seriously think that there is a "snowballs chance in hell" of a child being born here.

If not,
what do you think the chances are of a child being born? And how did you come to that conclusion?

And if there is a chance, do you think it would be reasonable to wait another 10 weeks and then lets the experts on the scene decide what the chances are?

I think the chances of a live child being born are slim, yes (I never said a snow balls chance in hell :pac:)

I came to that conclusion after reviewing the case reports available, and from what I know of current medical opinion in the area.

No, I don't think it would be reasonable to wait 10 weeks, as it would appear that the 'experts on the scene', as well as the woman's family are not in favour of that approach. On another note, I believe that spending a quarter of a million euro (minimum) of our health budget without good reason is unconscionable to me.

BarneyThomas

ProfessorPlum wrote: »

I think the chances of a live child being born are slim, yes (I never said a snow balls chance in hell :pac:)

ProfessorPlum wrote: »

The point is that this child has about as much chance as a snowball in a very fiery place of 'making it'.

ProfessorPlum wrote: »

No, I'm not preferring an anonymous source, merrily pointing out a source that I have no reason not to believe, and one it seems that has more access to actual information about this particular case. I'm surprised that you would deduce from my statement that I preferred it. How odd for a legal professional.

The journal article is hardly 'obviously referring to the likelihood of a live delivery" given that the authors could only find 2 cases of live birth after maternal brain death at or before a similar point to the present case under discussion.

You better work out the cases of live delivery after brain death as a percentage of deliveries after brain death then.

So thats 2 out of how many cases?

Not a very big dataset is it. Why would you even attempt to draw any conclusions from it?

ProfessorPlum

BarneyThomas wrote: »

Not a very big dataset is it. Why would you even attempt to draw any conclusions from it?

No it's not. Experience is very limited. I'd be inclined to be lead by the medical professionals who are involved in this case. It's a shame that we have to be lead by the legal ones.

bogwalrus

BarneyThomas wrote: »

Me being a doctor has nothing to do with what I know about the situation.
You should ignore that i said it completely.
I only mentioned it for the fact that i cant find out things either, with the resources i have available to me. And to point out that to say any specific % chances, never mind "a snowballs chance in hell" is just utter nonsense.

I know nothing of what is happening here, but that noone else here knows either.

All I know is it is in the hands of experts who do know what they are doing and have done this before. they will all be communicating with the doctors on site constantly.
They are the ones who ultimately will save this pregnancy.

I dont think its unreasonable to give this situation 10 weeks before making any decisions on whether the pregnancy will survive or not. Thats my point.

Even the experts involved here will come out of this with far more knowledge and experience that will measurably increase the likelihood of the next surviving.

This fetus should be given that chance. Medical research will benefit too, no matter what the outcome. And if a child is born it will have been worth it, and that, nobody can deny.

If you say you are a doctor and giving facts and a medical opinion on a medical situation it means I am more likely to take your points as accurate as you would be a qualififed professional on medical cases. There is also the issue that if you are not a doctor you can seriously mis inform people with your opinions that people will take as truths.

This is a very common thing on internet forums and I just want to make sure I'm not being spoon fed dressed up opinions.

conorh91

ProfessorPlum wrote: »

No, I'm not preferring an anonymous source, merrily pointing out a source that I have no reason not to believe, and one it seems that has more access to actual information about this particular case.

Regardless of whether the source was a nurse or a HSE manager, or whoever it was, it refers to a "high" possibility of foetal or infant death.

"High" is a delphic term that could be anywhere between 10% and 90%. Perhaps every patient in every ICU ward has a "high" chance of an adverse outcome such as death. It doesn't make them bed-blockers.

This is all making your earlier claims about bed blocking and lack of affordability look a bit silly.

the authors could only find 2 cases of live birth after maternal brain death at or before a similar point to the present case under discussion.

Three, including the instant case referred to in that paper. That's a reflection of the rarity of this type of case, not of a lack of success.

According to another paper, there were only 11 cases of irreversible maternal brain injury in pregnant women reported between 1979 and 2000. Eight referred to brain-stem death. There was one foetal mortality reported.

ProfessorPlum

BarneyThomas wrote: »

You better work out the cases of live delivery after brain death as a percentage of deliveries after brain death then.

That's going to be difficult as in my experience, clinicians are very excited to write up new and novel case reports, particularly when the outcome is positive, but are less likely to be enthused about writing up a case where the outcome is less exciting. So I think we would have difficulty in finding any meaningful statistics.
Perhaps with the recent advent of compulsory clinical audit, we might be able to gather more meaningful statistics in many areas.