Traumatic brain injury in obstetric patients: challenges and management strategies

Objective: To provide a conceptual framework for the management of traumatic brain injury (TBI) in pregnant women, integrating pathophysiological foundations, available scientific evidence, and current clinical strategies to support decision-making. Materials and methods: Based on a hypothetical case that practically illustrates the topic, an explanatory document was developed using a structured narrative review. It describes the physiological changes of pregnancy relevant to TBI, the principles of initial resuscitation, the management of intracranial hypertension, the use of neuromonitoring, obstetric care, and the ethical implications associated with maternal death by neurologic criteria. Results: Pregnancy involves anatomical and functional adaptations that alter the maternal response to trauma. These modifications affect the airway, hemodynamics, oxygenation, and cerebral autoregulation, necessitating adjustments in clinical management. Key aspects include initial stabilization, control of intracranial hypertension, neuromonitoring, obstetric care, and ethical considerations in scenarios of maternal death by neurologic criteria. Conclusions: The management of TBI in pregnant patients is a clinical challenge that requires an understanding of maternal physiology and its impact on acute brain injury. Given the lack of specific guidelines and recommendations, those established for the general population should be applied with careful consideration of the physiological changes of pregnancy.