Palliative care with pregnant women

Abstract When a pregnant woman has been declared dead because of brain death or cerebral death and a permanent vegetative state, the life and wellbeing of her fetus become a matter of crucial consideration. The possible options are an immediate caesarean section, continuation of efforts to maintain the organ functions of the woman to allow her fetus to mature, or discontinuation of the woman's somatic organ support. The decisions depend on the viability of the fetus, the probable health status of the fetus, any wish expressed by the mother and the commitment of her next of kin. Maintaining the pregnancy in order for the fetus to become more mature requires counselling of the woman's partner or family members. Immediate recourse of caesarean section should be withheld if the fetus is too immature or has a probable poor health status. Terminally ill pregnant women may require treatments which are potentially harmful to their fetus. Medical abortion early in pregnancy or premature delivery later in pregnancy are the usually recommended options. When the fetus is viable although extremely premature, delivery should not be imposed on a woman concerned with the risk of leaving a possibly handicapped child after her death.