Obstetric care of Jehovah’s Witnesses: a 14-year observational study

Abstract

Over a 14-year period, the obstetric outcome of Jehovah's Witnesses in an inner city hospital was reviewed and the effect of refusal of blood on morbidity and mortality evaluated. Ninety women had 116 deliveries and of these, 24% were delivered by caesarean section, 10% had instrumental deliveries and 66% were normal vaginal deliveries. Postpartum haemorrhage of >1,000 mls occurred in 6% and postpartum anaemia was the commonest complication. The mean postdelivery haemoglobin (11.10 +/- 1.15 g/dl) was not significantly less from the mean predelivery haemoglobin level (11.81 +/- 1.62 g/dl) (P > 0.05, paired t test). The single maternal death occurred after caesarean hysterectomy, which when extrapolated, resulted in a 65-fold increased risk of maternal death compared to the national rate. The optimum management of pregnant women who decline transfusion is discussed.

Caring for pregnant women for whom transfusion is not an option. A national review to assist in patient care

“…Good‐quality evidence to inform management of pregnancy where transfusion is not an option is generally lacking. 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 are drawn from cohort studies, cross‐sectional studies, case series and case reports, as well as from physiological principles and expert opinions . 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.…”

“…Many such women have uneventful pregnancies. However, two observational studies from high‐risk obstetric units suggest that refusal of transfusion in major PPH may be associated with a much higher risk of mortality (up to 44–65 times higher) compared to the general obstetric population …”

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

Prise en charge anténatale des patientes à risque d’hémorragie du post-partum (hors anomalies de l’insertion placentaire)

“…Des études observationnelles américaine, anglaise et hollandaise ont établi que le refus de recourir à la transfusion augmente le risque de décès maternel en situation d'hémorragie (NP4) [7][8][9]. La prise en charge de ces patientes doit être formalisée une fois que l'obstétricien et l'anesthésiste ont rencontré la patiente, ainsi que son compagnon et éventuellement d'autres membres de l'entourage (avis d'experts) [2].…”

Scope of Blood Transfusion in Obstetrics

“…The discussion should also include possibility of hysterectomy, morbidity and possibility of death. Two large case series in UK (Massiah et al 2007) and USA (Singla et al 2001) looked into the obstetric outcome of the labour and deliveries in Jehovah's witnesses. The reported mortality rate is 65 fold higher in the UK and 44 fold higher in USA.…”