Management of acute brain injury in pregnant patients what is different?

PURPOSE OF REVIEW: To establish the anatomical and physiological basis for understanding the differences in the evaluation, diagnosis, and management of pregnant women with acute brain injury (ABI). RECENT FINDINGS: Underline the absence of specific guidelines and the limited available literature, demonstrating marked variability and heterogeneity in the management of critically ill pregnant women with primary neurological damage. SUMMARY: "Two lives at risk" highlights the importance of a comprehensive approach to the mother and the fetus. Understanding the systemic and cerebral physiological adaptations induced by pregnancy constitutes the basis for supporting therapeutic interventions. Maintaining the functional integrity of the maternal-fetal unit is essential for both lives. The evaluation and categorization of ABI is fundamental and should be based on three pillars: neurological and systemic clinical examination associated with neuroimaging; pregnancy status (maternal-fetal unit) and fetal viability. Additionally, decision-making involves sociocultural, emotional, and medicolegal factors that must always be kept in mind.