استمرار الحمل لعدة اسابيع
او شهور حتى ولادة اطفال طبيعيين من امهات
تم تشخيصهن ( موتى مخياً )
وذلك بمجرد استمرار الرعاية الطبية لهن بعد رفض الاهل قتلهن
وانتزاع اعضائهن عن طريق اطباء نقل الاعضاء
استمر الأطباء لأول مرة في تقديم العناية الطبية
إلى مريضة حامل بعد تشخيصها بأنها
ميتة مخياً فقد استمر الحمل حتى وضعت طفلاً
طبيعياً .. وقد أوردت هذا البحث لأول
الأمريكية عام 1982 ومن
البديهي أن هذه الظاهرة تسقط تماماً أكذوبة مايسمى بموت المخ
ولذلك فلقد وصفت
بعض المراجع الطبية هذه الظاهرة عند إعلانها بأنها القشة التي
تقصم ظهر البعير
لمفهوم موت المخ
The straw that breaks the
2. توالت بعد ذلك الأبحاث و نشرت مجلة
الأمريكية عام 1988 المزيد من الأبحاث عن استمرار الحمل في
نساء موتى مخياً حتى أصبح ذلك حقيقة طبية ثابتة ... وقد مثل
ذلك إحراجاً كبيراً للأطباء المؤيدين لأكذوبة موت المخ.. و قد
عبر أحد الأطباء عن الإحراج الشديد الذي يتعرض له أطباء نقل
الأعضاء من جراء هذه الظاهرة حيث قال في ندوة التعريف الطبي
للموت التي عقدت في الكويت في ديسمبر 1996 إنه إذا صح ذلك فإن
هذا يعتبر ( إتهاماً لنا بالقتل ).. صفحة 328 من كتاب الندوة .
3. تزايدت في السنوات الأخيرة الأبحاث
التي أجراها أطباء نقل الأعضاء في دول العالم المختلفة على
حالات الحمل والولادة لأطفال طبيعيين من أمهات موتى مخياً
وأصبحت هذه الحالات تعرف في المراجع العلمية باسم
ويمكن لأي مهتم الاطلاع على هذه الحالات في المراجع الطبية وقد
بلغ عدد الحالات في بحث واحد نشرته مجلة طب الحالات الحرجة
الأمريكية في أبريل 2003 ( 11 حالة ) اكتمل الحمل والولادة في
عشر حالات ووضعن أطفالاً طبيعيين .. كما أن وسائل الإعلام
الأوربية والأمريكية تعرض الكثير من هذه الحالات أولاً بأول .
ومن الجدير بالذكر أن الأطباء
المروجين لنقل الأعضاء في مصر مازالوا يصرون على إنكار هذه
الحقائق الثابتة لخداع الرأي العام في مصر.. ولذلك فإننا نرفق
في الصفحات التالية بعض الأبحاث المنشورة في المجلات الطبية
العالمية التي تتناول عشرات من حالات سيدات موتى مخياً استمر
الحمل لديهن لفترات زادت عن المائة يوم ووضعن أطفالاً طبيعيين
بعض الأفلام التي
أذيعت في محطات التليفزيون العالمية لحالات استمرار
الحمل والولادة في نساء موتى مخياً !!
قناة ABC الأمريكية
إمرأة حامل في الشهر السادس تصاب بموت المخ.
الأطباء يضعونها على أجهزة الإعاشة ويراقبون نمو
الجنين بأجهزة السونار.
بعد عدة أسابيع يتم توليد الأم بعملية قيصرية.
الأم المصابة بموت المخ تضع طفلة حية بصحة جيدة.
بعد 48 ساعة من الولادة يتم فصل أجهزة الإعاشة
تم انتزاع أعضاء الأم لزرعها في مرضى آخرين.
قناة CBS channel 5
إمرأة حامل تصاب بموت المخ.
الأم يتم وضعها على أجهزة الإعاشة لمدة 3 شهور كاملة .
الأم تضع طفلة حية بعملية قيصرية.
يتم فصل الأم عن أجهزة الإعاشة بعد الولادة.
قناة ABC الأمريكية
إمرأة حامل في هاواي أعلنت
وفاتهاالمخيةdeclared brain dead في 25 نوفمبر 2005
ووضعت على أجهزة الإعاشة ثم وضعت مولوداً حياً
في 12 ديسمبر 2005
بعد الولادة تم فصل أجهزة الإعاشة ونزع كبدها
وكليتيها لاستخدامها في عمليات نقل الأعضاء.
التي ولدت من أم ميتة مخياً كما يزعمون بعد أن نمت
نمواً طبيعياً !!
بعض الأبحاث من المجلات الطبية العالمية التي
تتناول ظاهرة استمرار واكتمال الحمل لدى النساء
Crit Care Med. 2003 Apr;31(4):1241-9.
support for pregnant women after brain death.
Powner DJ, Bernstein
Neurosurgery, University of Texas, Houston, TX,
To review case reports of pregnant women who
have been supported after brain death until
successful delivery of their infants. From these
reports and other literature about brain death,
normal physiologic changes of pregnancy, and
specific needs for fetal development,
recommendations were made to assist in
supporting pregnant women after brain death
until delivery of a mature fetus who is likely
Personal files and experiences, MEDLINE review
of case reports and publications about
physiologic changes present during normal
pregnancy and after brain death, and the
critical needs for fetal development were
included. DATA EXTRACTION:
of ten patients comprise the accumulated
clinical experience. Hypotension,
requiring fluid administration and inotropic/vasopressor
therapy, occurred in all the mothers, and in six
cases, was the reason for urgent delivery.
period of support was 107 days, from 15 to 32
wks of gestation. Two mothers also
became organ donors. Recurrent infections,
thermolability, and other complications common
to prolonged ICU care were encountered. All
infants survived. One had congenital
abnormalities caused by phenytoin use by the
mother. When followed, all others developed
within normal growth and mental variables. These
cases plus literature citations noted above were
used to develop recommendations for
CONCLUSION: Preservation of
uterine/placental blood flow is the most
important priority during somatic support.
Imprecise autoregulation of the uterine
vasculature during maternal hypoxemia or
hypotension makes this goal a significant
challenge. Special considerations for nutrition;
medication use; cardiovascular, respiratory, or
endocrine therapy; fetal monitoring; hormone
replacement; and ethical concerns are discussed.
Reprod Health. 2006 Apr 27;3:3.
The prolongation of
somatic support in a pregnant woman with brain-death: a case
Pinto e Silva JL.
Intensive Care Unit,
Department of Obstetrics and Gynecology, School of Medical
Sciences, State University of Campinas, Campinas, São Paulo,
Medical literature has increasingly reported cases of
maternal brain death during pregnancy. This is a rare
situation which demands the decision and, depending on the
gestational age, the implementation of a set of measures to
prolong the homeostasis of the human body after brain death
for the purpose of maintaining the foetus alive until its
viability. CASE PRESENTATION:
A 40 year old woman
suffered an intracranial haemorrhage
during the 25th week of
pregnancy. Despite neurosurgical drainage of a
gross intraparenchymatous haematoma, the patient
developed brain death. Upon confirmation of this
diagnosis, she received full ventilatory and nutritional
support, vasoactive drugs, maintenance of normothermia,
hormone replacement and other supportive measures required
to prolong gestation and improve the survival prognosis of
her foetus. All decisions regarding the patient's treatment
were taken in consensus with her family. She also received
corticosteroids to accelerate foetal lung maturity. During
the twenty-five days of somatic support, the woman's
condition remained stable; however, during the last seven
days the foetus developed oligohydramnios and
brain-sparring, which led the medical team to take the
decision to perform a Caesarean section at that moment.
After delivery, the patient's organs were removed for
donation. The male infant was born weighing 815 g, with an
Apgar score of 9 and 10 at the first and fifth minutes,
infant was admitted to the neonatal intensive care unit,
but did not require mechanical ventilation and had no major
complications. He was
discharged at 40 days of life, with no sequelae and weighing
CONCLUSION: These results are in accordance with
findings from previous studies and case reports suggesting
the appropriateness and safety of extended somatic support
during pregnancy under certain circumstances. They also
suggest the need for prompt diagnosis of brain death before
the occurrence of physiological degeneration, rapid
evaluation of foetal status and the decision of the family
together with the medical team to prolong maternal somatic
support. The occurrence of maternal brain death is a
tragedy, but it may also represent a challenging opportunity
to save the life of the foetus and, in addition, permit
donation of the maternal organs.
Obstet Gynecol Surv. 2000 Nov;55(11):708-14
brain injury during pregnancy: a case report and review of
Department of Obstetrics and
Gynecology, University of Connecticut Health Center,
Farmington 06030-2950, USA. firstname.lastname@example.org
Maternal brain death or
massive injury leading to persistent vegetative state during
pregnancy is a rare event. Since 1979,
11 cases, including the
current one, of irreversible maternal brain damage in
pregnancy have been reported.
In all but one, the pregnancies were prolonged with a
goal of achieving delivery of a viable infant.
Current advances in medicine and critical care enable
today's physician to offer prolonged life-support to
maximize the chances for survival in the neonate whose
mother is technically brain dead. We present a case at our
institution and review all previously published cases in the
English literature for comparison as well as make management
Journal of the American
1988 Aug 12;260(6):816-22.
Maternal brain death
during pregnancy. Medical and ethical issues.
Gates EA, Creasy RK, Jonsen AR,
Laros RK Jr.
Department of Obstetrics,
Gynecology, University of California, San Francisco
We present in detail a case
of a 27-year-old primigravida
who was maintained in a
brain-dead state for nine weeks.
An apparently normal and healthy male infant weighing 1440 g
was delivered. The
newborn did well and was found to be growing and developing
normally at 18 months of age. Although the
technical aspects of prolonged life support are demanding
and the economic costs are very high (+217,784), there are
ample ethical arguments justifying the separation of brain
death and somatic death and the maintenance of the
brain-dead mother so that her unborn fetus can develop and
KIE: Physicians and an
ethicist at the University of California, San Francisco,
present the details of the case of a pregnant, brain-dead
woman whose vital functions were maintained for nine weeks
until the delivery of a healthy infant at 31 weeks'
gestation. Despite the technical difficulties involved and
the economic costs incurred ($183,031 for maternal care and
$34,703 for neonatal care), the authors conclude that
ethical considerations support the decision on care. They
argue that the woman was not injured; that nonmaleficence
and beneficence toward the fetus require a rescue attempt if
there is a reasonable chance of reaching fetal maturity;
that maternal medical care may be more cost effective than
prolonged neonatal support; and that the father's wishes
were respected. Rather than proposing guidelines, they hold
that decisions on prolonged maternal support should be based
on the circumstances of each case.
Journal of the American
1982 Sep 3;248(9):1089-91
Life support and maternal
death during pregnancy
Dillon WP, Lee RV, Tronolone
MJ, Buckwald S, Foote RJ.
KIE: The authors are
physicians affiliated with the State University of New York
at Buffalo and the Children's Hospital of Buffalo. They
describe the clinical management of
two brain-dead pregnant
women and suggest guidelines to help physicians
decide whether to treat such women. Based on the
dramatically increasing chances for fetal survival from the
24th to the 27th weeks of gestation, they recommend vigorous
life support during this period to permit fetal viability
and prognosis to be assessed.
Fetuses of 28 weeks should
be delivered by cesarean section as soon as practicable
after confirmation of maternal brain death.
Promoting thoughtful, balanced reflection on the
ethical and social issues of medicine and
Hastings Cent Rep. 1986 Feb;16(1):12-7
On dying more than one deathShrader
Death (with a capital D) can
best be understood as a series of distinct but related
deaths. For example, a
pregnant woman was found to be brain-dead but her vital
functions were artificially sustained for nine weeks until
her fetus could be delivered, after which the machines were
removed and she died a second, conceptually distinct death.
This procedure is probably justifiable, but any legislation
or policy regarding such cases should be flexible and should
KIE: It is argued that death
should be understood as encompassing a series of distinct
but related events. Human beings are viewed as a composite
of two intimately related but distinguishable components, as
both persons and biological entities. Thus, a brain dead
patient can be considered in some sense alive and in some
sense dead. This thesis forms the basis for an analysis of a
case in which a brain dead pregnant woman's vital functions
were artificially sustained until her fetus could be
delivered alive, after which the woman's life support
systems were disconnected and she ceased breathing. The
author holds that this procedure was morally justifiable. He
suggests that a multiple-deaths analysis may provide a
general framework for discussion of the conditions that
justify maintenance of biological functions in neocortically
dead human beings, but cautions that any legislation or
policy regarding such cases should be flexible and should
Revista médica de Chile
Med Chil. 1998 Apr;126(4):450-5.
Maternal brain death during
[Article in Spanish]
Beca JP, Wells W, Rubio W.
Medicina, Universidad de Chile.
The case of a pregnant
patient who had a massive intracraneal haemorrhage at 18
weeks of gestation is presented.
Patient's neurological damage evolved to brain death, but
the fetus continued in good condition. The
decision of withdrawing life support or to continue
supporting the mother's life to allow fetal development
aroused difficult ethical questions, both to relatives and
professionals. This is an exceptional situation of a heart
beating cadaver and a non viable fetus whose life depends on
the continuation of treatments that are considered as
experimental. A good decision should be based on the respect
to a body in brain death, the fetal right to life, family's
wishes and values, the use of experimental treatments, and
the rational use of a public hospital's resources. The
conclusion was that the continuation of life support
treatments was not an ethical obligation. Withdrawing life
support to allow fetal death in this case means foregoing an
experimental treatment and to respect family's autonomy and
the right of the patient's death with dignity.
Similar cases need to be
discussed with a multidisciplinary analysis in
their own particularity.
Critical Care Clinics
Care Clin. 2004 Oct;20(4):747-61
resuscitation and somatic support of the pregnant patient.
Mallampalli A, Powner DJ,
Section of Pulmonary and
Critical Care Medicine, Baylor College of Medicine, Ben Taub
General Hospital, 1504 Taub Loop, 6th Floor, Houston, TX
77030, USA. email@example.com
during pregnancy is a rare event that critical care
clinicians must be prepared to manage. The causes of
cardiopulmonary arrest during pregnancy, recommended
modifications to cardiopulmonary resuscitation protocols
that are specific to pregnancy, indications for and
timing of perimortem cesarean delivery, and the expected
fetal outcomes are reviewed. Rarely, brain death of a
pregnant patient may occur in which continued support of
the mother is possible to prolong the pregnancy and
improve fetal outcome. Prolonged somatic support of
pregnant patients who are brain dead presents specific
management challenges, but has been accomplished. The
physiologic changes that occur after brain death and
recommendations for somatic support of the brain dead
pregnant patient also are reviewed.
Care Med. 2005 Oct;33(10 Suppl):S325-31.
Cardiac arrest in pregnancy
and somatic support after brain death.
Mallampalli A, Guy E.
Section of Pulmonary and Critical Care Medicine, Department
of Medicine, Baylor College of Medicine, Houston, TX, USA.
OBJECTIVE: To review the important causes of cardiopulmonary
arrest during pregnancy and the recommended modifications to
resuscitation protocols when applied to pregnant patients,
including the indications for perimortem cesarean section
and the expected fetal outcomes, and to review the
literature regarding extended somatic support after brain
death during pregnancy. DATA SOURCES: MEDLINE review of
publications relating to cardiac arrest and resuscitation in
pregnancy, physiologic changes after brain death, and
attempted somatic support of brain-dead pregnant women.
CONCLUSIONS: Cardiac arrest during pregnancy is rare, but it
is important to recognize the causes, which may be either
unrelated to pregnancy or unique to the pregnant woman. For
the most part, the resuscitation protocol is the same as for
nonpregnant victims of cardiac arrest, with a few important
modifications, including especially the need for relieving
aortocaval compression by the gravid uterus, the need for
rapid intubation, and the importance of rapid perimortem
cesarean delivery when indicated. In those rare cases of
brain death occurring in a pregnant patient, continued
somatic support of the mother may be possible, even for
prolonged periods, to extend the pregnancy and further fetal
maturation. The expected physiologic changes after brain
death, challenges to successful somatic support, and
specific recommendations regarding organ support of the
brain-dead pregnant woman are reviewed.
Neurocrit Care. 2005;3(2):99-106
Maternal brain death and
Farragher RA, Laffey JG.
Department of Anaesthesia, University College Hospital, and
Clinical Sciences Institute, National University of Ireland,
Brain death is a concept used in situations in which
life-support equipment obscures the conventional
cardiopulmonary criteria of death, and it is legally
recognized in most countries worldwide.
Brain death during
pregnancy is an occasional and tragic occurrence. The mother
and fetus are two distinct organisms, and the death of the
mother mandates consideration of the well-being of the
fetus. Where maternal brain death occurs after the onset of
fetal viability, the benefits of prolonging the pregnancy to
allow further fetal maturation must be weighed against the
risks of continued time in utero,
and preparations must be made to facilitate urgent cesarean
section and fetal resuscitation at short notice. Where the
fetus is nonviable, one must consider whether continuation
of maternal organ supportive measures in an attempt to
attain fetal viability is appropriate, or whether it
constitutes futile care. Although the gestational age of the
fetus is central to resolving this issue, there is no clear
upper physiological limit to the prolongation of somatic
function after brain death. Furthermore, medical experience
regarding prolonged somatic support is limited and can be
considered experimental therapy. This article explores these
issues by considering the concept of brain death and how it
relates to somatic death. The current limits of fetal
viability are then discussed. The complex ethical issues and
the important variations in the legal context worldwide are
considered. Finally, the likelihood of successfully
sustaining maternal somatic function for prolonged periods
and the medical and obstetric issues that are likely to
arise are examined.
Journal of transplant
Transpl Coord. 1997 Sep;7(3):103-5.
dead Organ recovery
following childbirth by a brain-mother: a case report.
Lewis DD, Vidovich RR.
Ohio Valley LifeCenter,
Little information is
available in the medical and nursing literature concerning
organ recovery from brain-dead, pregnant individuals.
Many healthcare professionals might rule out such patients
as potential donors, especially if childbirth is a
possibility. This article presents an actual case study in
which the birth of a
healthy infant and recovery of organs from the
mother were successful. It also reviews the available
literature and discusses factors related to organ placement.
Journal of Obstetrics and
Obstet Gynecol. 1989 Sep;74(3 Pt 2):434-7.
Maternal brain death and
prolonged fetal survival.
Bernstein IM, Watson M,
Simmons GM, Catalano PM, Davis G, Collins R.
Department of Obstetrics and Gynecology, Medical Center
Hospital, Vermont, Burlington.
A 30-year-old woman suffered
massive brain injuries after a motor vehicle accident at 15
weeks' gestation. The
patient was diagnosed as brain-dead on her tenth hospital
day. She was supported with intensive care for 107 days
after this diagnosis, and a normal 1555-g male
infant was delivered at approximately 32 weeks' gestation by
repeat cesarean section. The child is developing normally at
11 months of age. This
represents the longest reported case of prolongation of
pregnancy after brain death
A Journal on Anesthesiology,
Resuscitation, Analgesia and Intensive Care
Minerva Anestesiol. 1992 Nov;58(11):1247-52.
Brain death and prolonged
Antonini C, Alleva
S, Campailla MT, Pelosi G, Valle E, Verrua M, Zamponi E,
Blanda A, Gambaro C.
Medicina e Chirurgia, Università degli Studi di Torino.
The Authors presents in
detail a case of a 25-year-old primigravida that had fatal
intracranial bleeding at the
beginning of the 15th week
of gestation, whose vital function are sustained for 49
days. Despite the insuccess to bring the pregnancy to a
gestational period favorable to induce the delivery,
they analyse the problems connected to the maternal
maintenance and to the fetal growth.