How to Manage Venous Sinus Thrombosis (VST) in a Young Pregnant Woman: To Deliver or Not? An Ethical Case Report

Abstract

Background: Cerebral venous sinus thrombosis (CVST) during pregnancy is a rare but potentially life-threatening condition that presents complex medical and ethical challenges, particularly when the patient is in a coma. Case Presentation: A 19-year-old woman, eight weeks pregnant, was admitted with severe headache, vomiting, anorexia, and altered consciousness. Neuroimaging revealed extensive thrombosis of the dural venous sinuses. She required intubation and antimicrobial treatment due to suspected intracranial infection. Despite medical management and decompressive surgery for intracranial hypertension, she developed complications, including infection, intracranial abscess, oral bleeding, and an arterial ischemic event. Following slight improvement and subsequent stabilization, voluntary termination of the pregnancy was performed 66 days after admission. The patient passed away ten days later, with no further resuscitation efforts. Discussion: This case highlights the medical and bioethical dilemmas in managing pregnant women in a coma. A multidisciplinary approach involving neurologists, intensivists, obstetricians, and ethics specialists is essential. While specific guidelines for such scenarios are lacking, literature on pregnant patients with brain death provides comparable ethical frameworks. Conclusion: Managing critically ill pregnant women with neurological conditions requires a comprehensive consideration of maternal and fetal prognosis. Ethical decisions should integrate medical prognosis, fetal viability, and family perspectives within a multidisciplinary context, ensuring dignified and evidence-based care.