1506 - Navigating Reproductive Rights in the Management of Traumatic Brain Injury: A Case Report

Case Diagnosis: Incidental Pregnancy in Severe Traumatic Brain Injury

Case Description: A 28 year old woman sustained a severe TBI following a hang-gliding accident. At evaluation, she was incidentally found to be 8 weeks pregnant. Despite improvement during her acute care admission, she was determined to lack decision making capacity. Her parents felt pregnancy termination was consistent with her premorbid wishes. However, restrictive abortion legislation limited care. Ethics deemed intervention non-emergent and deferred definitive care pending cognitive improvement. She was discharged to inpatient rehabilitation in a state with legal protections for abortion access.



Her initial evaluation demonstrated impairments in memory, cognition, attention, and impulse control. Donepezil and Methylphenidate were started with improvement in O-log scores and attention. However, she continued to have cognitive impairment and post-traumatic amnesia. Her parents sought legal guidance and were granted guardianship, partly to facilitate abortion care. Despite persistent deficits, she was discharged from IRF after 2 weeks for dilation and evacuation within her pregnancy’s second trimester.

Discussions: In June 2022, the Supreme Court overturned Roe v. Wade with its Dobbs decision and removed federal protections for abortion care nationwide. Several states have since instituted restrictive legislation on reproductive rights, resulting in fear and uncertainty for medical providers. This changing landscape has significant implications for individuals with disabilities, particularly those with impaired medical decision making capacity.



Here, we describe the acute inpatient rehabilitation course for a pregnant woman with Traumatic Brain Injury (TBI) including the impact of the Dobbs decision on her care. Restrictive abortion legislation delayed the execution of the patient’s wishes and ultimately interfered with her rehabilitation course as she required early discharge from IRF.

Conclusions: Although reproductive rights legislation may seem less pertinent to Physical Medicine and Rehabilitation, these issues are salient for patients with impaired cognition and decision making capacity.