27-year-old woman;

at week 36 of gestation;

head shot;

stabilized and on life support.

Critical state.

This was the scenario that the doctors from the Clinical University Hospital of Valencia found themselves yesterday when they received the pregnant young woman of Lithuanian nationality.

She finally passed away, but the doctors who assisted her managed to save the life of her little one after performing a caesarean section on her mother before she died.

What complications can occur in these situations?

The gynecologist Santiago Palacios explains that "the most important thing in these situations is deciding when to carry out the extraction of the baby; that is, to remove it from the mother's womb or not and at what time. In this case, it has acted well for two reasons : Firstly, because

from 36 weeks of gestation and while the child was alive, with heart rate, blood flow and oxygenation, the baby was sufficiently mature

".

Secondly, Palacios adds that "in a state as acute as the one in which the mother was, by performing a cesarean section while she was alive, you

remove the excess weight of the pregnancy

, which allows you to do many more things without harming the child and you have to act quickly".

How do you decide to perform a cesarean section in similar situations?

The time to perform a cesarean section, "in emergent or urgent cases of this type, is established thinking about the benefit of the fetus and the mother, and in this case there was no doubt. You can doubt in the 30th week of gestation,

but at 36 no

," says Dr. Palacios.

What happens in the event that the mother had been brain dead?

Given the vital conditions in which the young woman arrived at the hospital, it would be expected that the doctors would have found a brain-dead patient.

"In these situations, it is considered that these patients are dead, at least brain-dead, and you keep them alive," says Palacios.

In these situations

it may be the case that the pregnancy continues by providing the mother with life support

.

«In fact, a tremendous controversy has arisen because someone has thought of saying that these people, these women who are in ICUs and alive because their hearts continue to beat even though they are brain dead, could serve as wombs for surrogate pregnancies. », points out this gynecologist.

In these cases, is a cesarean section performed like the others?

"The incision is very clear: 12 to 15 centimeters, transversal and two centimeters from the pubis. Then a very quick en bloc suture of everything that is the uterus. In this case, it is about doing it very quickly to avoid, above

all , the hemodynamic problem

", explains Palacios.

The challenge, in situations such as that of the young Lithuanian woman shot in the head, "is to maintain the blood supply and not to lose more blood than usual in these procedures to keep the mother and fetus alive. The challenge is for the anesthetist," he says.

And what happens once the child is taken out?

"If the mother bleeds too much, because in these procedures it can happen,

you have to have the operating room ready

in case you have to proceed with a hysterectomy (removal of the uterus)," Palacios details.

He also adds that all decisions will have been made jointly between the intensive care doctor, the anesthetist and the gynecologist.

"When the mother died hours after taking the baby out of her, already mature, it has shown that they have done the right thing," she concludes.

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  • Gynecology