Obstetric Care of Jehovah’s Witnesses: A 14-Year Observational Study

Balloon tamponade for postpartum vaginal lacerations in a woman refusing blood transfusion

“…Approximately 150 000 Jehovah's Witnesses live in the UK and it is estimated that pregnant women have a 65‐fold increased risk of maternal death due to hemorrhage [2]. This can be partly attributed to their refusal to accept blood, but also highlights the speed with which obstetric hemorrhage can occur.…”

Caring for Pregnant Women for Whom Transfusion is Not an Option. A National Review to Assist in Patient Care

“…Small numbers of patients, geographical, cultural and political differences, clinical and haematological heterogeneity, and ethical principles preclude against level 1 or 2 evidence, so most data is drawn from cohort studies, cross-sectional studies, case series and case reports, as well as from physiological principles and expert opinions 3,4 . While this may limit the strength of any generalisations that can be drawn from the literature, these recommendations aim to provide a framework for the provision of optimal obstetric care in this challenging circumstance.…”

“…In some situations, however, transfusion may not be possible, either because patients have rare blood groups or complex antibodies, or, more commonly, where patients refuse transfusion of blood products for personal or religious reasons. Many such patients have uneventful pregnancies, however two observational studies from high-risk obstetric units suggests that refusal of transfusion in major postpartum haemorrhage may be associated with a much higher risk of mortality (up to 44-65 times higher) compared to the general obstetric population 1,3,5 . While patients with rare blood groups or complex antibodies will still be able to receive platelets and fresh frozen plasma, the management of patients refusing blood products is more complex due to fewer appropriate therapeutic options.…”

“…Recommendations are for two consultant obstetricians to be present where practical 3 , to avoid hypothermia which would exacerbate coagulopathy (use fluid warmer, Bair TM hugger or similar) and have cell salvage available. A subtotal procedure may be quicker than total hysterectomy; however the choice of procedure is by surgeon preference.…”

How we manage the haematological aspects of major obstetric haemorrhage

“…There are additional challenges in the management of mothers refusing blood transfusion, including for religious reasons, i.e., Jehovah's Witnesses, with a higher risk of morbidity and mortality (Singla et al, 2001;Massiah et al, 2007;van Wolfswinkel et al, 2009). All women declining blood transfusion require careful multidisciplinary planning with senior clinician input during pregnancy to minimize anaemia and to manage bleeding.…”