Coma

INFORMATION FOR WOMEN WHO ARE CONCERNED ABOUT COMA WHILE PREGNANT

The information provided below is for readers based in the United States of America. Readers outside of the United States of America should seek the information from local sources.

What is a coma during pregnancy?

A coma is a state of unconsciousness that is deeper than sleep, and that usually lasts for a prolonged period. Usually, coma is caused by injury (especially traumatic brain injury) or disease. It lasts for an indefinite amount of time, but it can also be induced intentionally by doctors to protect the brain in certain circumstances. Examples of medical conditions that can lead to coma include strokes, ongoing seizures, diabetes (when it is not controlled, and blood sugar level gets extremely high or extremely low), infections, and tumors. Various toxins also can cause a coma, as can any situation leading to a lack of oxygen reaching the brain, including blood loss, cardiac arrest (lack of effective pumping of the heart), and drowning.

Coma in pregnancy can occur from any of the same reasons that it occurs outside of pregnancy, plus it can result from certain severe complications of pregnancy, such as preeclampsia and eclampsia, HELLP syndrome, gestational hypertension (high blood pressure of pregnancy), and from strokes resulting from changes in the body related to pregnancy. Pregnant women also can develop clots in the spaces where venous blood from the brain collects, which could cause coma, plus there are organ failure conditions related to pregnancy that can lead to coma.

How common is a coma during pregnancy?

There is no single set of statistics on the occurrence of a coma in pregnancy overall, but some of the more common causes of coma affect pregnant women more often than non-pregnant women matching in age and other risk factors. Pregnancy carries an elevated risk to form clots in deep veins, for example, which can lead to emboli, clots that travel through the veins. This can lead to pulmonary embolism (a clot in the lungs), but in some women (those who have what is called a patent foramen ovale [PFO]), emboli can travel from the right to the left side of the heart and get to the brain, causing an embolic stroke. Strokes occurring in the brain stem, as well as strokes involving blood vessels that supply large fractions of the cerebral cortex, can cause a coma. Preeclampsia, a complication of pregnancy, increases the risk of stroke by four times. Diabetic coma can occur just as easily in pregnant women with uncontrolled diabetes as with non-pregnant women with the same condition. However, gestational diabetes (diabetes that develops only due to pregnancy) does not ever lead to a coma.

It is important to keep in mind that, excluding women with severe disease and/or organ dysfunction who happen to become pregnant, coma is so rare during pregnancy that when it occurs, it typically is the subject of a news report. Among such cases are a handful of examples in which women have become pregnant while comatose, rather than before falling into a coma, meaning that caretakers have been implicated.

How is a coma during pregnancy diagnosed?

Whether a person is pregnant or not, a coma is diagnosed by assessing the persons level of alertness and neurological responsiveness. This is done by giving various body functions a number rating as criteria that are added together on a rating system. The most common system is called the Glasgow Coma Scale (GCS), which is based on the assessment of eye-opening, verbal responses, and motor response. On the GCS, a score of 8 or less is considered severe, 9-12 is moderate, and 13-15 is mild. Other rating systems relevant to coma include the cerebral performance category (CPC), which is used frequently to assess patients after cardiac arrest). The electrical activity of the brain is assessed with electroencephalography (EEG). Assessment of a comatose patient also typically includes various laboratory tests on samples of blood, cerebrospinal fluid, and urine, and brain imaging, such as magnetic resonance imaging (MRI) or computed tomography (CT) scanning. During pregnancy, MRI is preferred over CT, because CT exposes the woman to ionizing radiation. Various imaging tests of internal organs also will be conducted, depending on the particular circumstances of the coma.

Does coma cause problems during pregnancy?

Comatose people are unconscious with various other symptoms that typically include decreased neurological activity, such as pupils not responding to light, eyes being closed, limbs moving only through reflexes, lack of response to pain stimulation other than reflex responses, and breathing abnormalities the particular problems related to the cause of the coma.

Does coma cause problems for the baby?

When a pregnant woman is comatose, the prognosis for the baby depends greatly on the underlying cause of the coma. Trauma affecting the blood supply to the womb and severe organ dysfunction in the mother, for instance, all put the life and health of the fetus at extreme risk. On the other hand, if the mothers body functions are close to normal with the cause of the coma located in the brain, the pregnancy can continue to term, although the number of such cases that have been documented is small.

What to consider about taking medications when you are pregnant or breastfeeding:

  • The risks to yourself and your baby if you do not treat the coma
  • The risks and benefits of each medication you use when you are pregnant
  • The risks and benefits of each medication you use when you are breastfeeding

What should I know about using medication to treat a coma during pregnancy?

Numerous different medications are given, depending on the cause and nature of the coma. Patients are treated, at least initially, in the neurological intensive care unit, typically given fluids with sugar and various electrolytes, and often they require mechanical ventilation.

Who should NOT stop taking medication for a coma during pregnancy?

Since there are so many different reasons for coma, there are a great number of medications given, some of which can be stopped after a time, whereas others must be continued.

What should I know about choosing a medication for a coma during pregnancy?

It is important to stay in communication with your health care provider as the release of new studies over time can change the outlook on the role of specific medications during pregnancy.

You may find Pregistrys expert reports about the medications to treat this condition in here. Additional information can also be found in the sources listed below.

What should I know about taking a medication for a coma when I am breastfeeding?

Although it is physiologically possible for a comatose woman to lactate, and thus to breastfeed, in practice this is not usually done.

What alternative therapies besides medications can I use to treat a coma during pregnancy?

Once the acute condition leading t
o the coma has passed, a great deal of the management consists of monitoring the person with equipment and neurological examinations and maintaining fluid support and nutrition. In some instances of traumatic brain injury, cardiac arrest, and other conditions, coma can be induced to protect against brain injury, sometimes using drugs and sometimes by reducing the body temperature (therapeutic hypothermia). Such comas are easily reversible.

What can I do for myself and my baby when I have a coma during pregnancy?

A comatose person is unconscious and so is unable to make decisions on what to do for her baby. In such situations, family members are asked to make decisions.

Resources for coma in pregnancy:

For more information about coma during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or contact the following organizations:

 

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General information

It is very common for women to worry about having a miscarriage or giving birth to a child with a birth defect while they are pregnant. Many decisions that women make about their health during pregnancy are made with these concerns in mind.

For many women these concerns are very real. As many as 1 in 5 pregnancies end in a miscarriage, and 1 in 33 babies are born with a birth defect. These rates are considered the background population risk, which means they do not take into consideration anything about the health of the mom, the medications she is taking, or the family history of the mom or the baby’s dad. A number of different things can increase these risks, including taking certain medications during pregnancy.

It is known that most medications, including over-the-counter medications, taken during pregnancy do get passed on to the baby. Fortunately, most medicines are not harmful to the baby and can be safely taken during pregnancy. But there are some that are known to be harmful to a baby’s normal development and growth, especially when they are taken during certain times of the pregnancy. Because of this, it is important to talk with your doctor or midwife about any medications you are taking, ideally before you even try to get pregnant.

If a doctor other than the one caring for your pregnancy recommends that you start a new medicine while you are pregnant, it is important that you let them know you are pregnant.

If you do need to take a new medication while pregnant, it is important to discuss the possible risks the medicine may pose on your pregnancy with your doctor or midwife. They can help you understand the benefits and the risks of taking the medicine.

Ultimately, the decision to start, stop, or change medications during pregnancy is up to you to make, along with input from your doctor or midwife. If you do take medications during pregnancy, be sure to keep track of all the medications you are taking.


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