Decompressive craniectomy in term pregnancy with combined cesarean section for traumatic brain injury

Over the years the maternal mortality depending on the obstetric causes has reduced whereas there is a relative increase in maternal mortality and morbidity due to non-obstetric causes. Trauma during pregnancy, including head injury, is one of the leading causes of incidental maternal death and morbidity, and complicates 6%–7% of all pregnancies. Furthermore it predisposes two lives at risk and creates unique diagnostic and therapeutic challenges. Because of the physiological hormonal, hemodynamic and anatomical changes associated with pregnancy, certain standard neurosurgical practices may be challenged. We present a case of woman with term pregnancy who sustained moderate head injury requiring urgent caesarean section for pregnancy and decompressive craniectomy in the same sitting in Operation Theater. Issues like screening of mother and feto-maternal monitoring; physiological changes during pregnancy, choice of anaesthesia, intraoperative concerns and fetal monitoring, timing of delivery are discussed with review of pertinent literature.