Spontaneous in utero recovery of a fetus in a brain death-like state

Abstract

A healthy pregnant woman at 28 weeks of gestation was admitted with complete loss of fetal movement. Fetal heart rate (FHR) monitoring showed a fixed flat FHR pattern with no variability. Ultrasound examination revealed no fetal breathing movement. The fetus showed heart failure with extremely diminished left heart contractility. No abnormalities were found in the fetus. We assessed that the fetus was in a brain death-like status. After discussion, we decided not to deliver the baby but to monitor it carefully using FHR monitoring and continuous fetal ultrasound examinations, assuming the baby was dying or at least had little possibility of survival. However, 8 h after admission, FHR monitoring showed some variability and after another 12 h the fetus recovered completely. The baby was born at 35 week of gestation by cesarean section. The baby sustained some white matter brain damage, but with no significant clinical delay of motor development. This is a rare case of in utero recovery from a fetal brain death-like status.