The management of severe isolated traumatic brain injury in pregnancy: A joint consensus statement from the European Association of Neurosurgical Societies (EANS) and the World Society of Emergency Surgery (WSES)

Introduction: Severe traumatic brain injury (TBI) during pregnancy is a rare but challenging condition. There is scarce evidence in this population, and severe TBI management during gestation remains empirical and extrapolated from data on non-pregnant women. Material and methods: The World Society of Emergency Surgery (WSES) and the European Association of Neurosurgical Societies (EANS) collaborated to establish a multidisciplinary consensus panel of 115 physicians with vast expertise in the management of severe TBI, including cases of pregnant women. A modified Delphi approach was adopted. Two online questionnaires were conducted between February and June 2025. The list of statements (36) was distributed to the panelists to allow voting and to propose any comments and/or changes. The analysis of results was performed by an experienced non-voting methodologist. Statements were classified as strong suggestion, weak suggestion or no suggestion when >85%, 75–85% and <75% of votes were in favor, respectively. Results: A consensus was reached, generating 36 strong suggestions regarding several important aspects in the care of isolated severe TBI during pregnancy. Discussion and conclusions: This consensus provides practical suggestions to support a clinician's decision-making in the management of severe isolated TBI during pregnancy in high-income countries. However, these statements are based mainly on expert opinion, and further evidence is required in this field.