Obstetric outcomes in Jehovah’s Witnesses: case series over nine years in a London teaching hospital

Berg, Lauren; Dave, Arti; Ye, Huazhen; Wei, J; Pattanakamjonkit, P; Farah, M; Yoong, Wai

doi:10.1007/s00404-023-06940-x

Cited by 5 publications

(3 citation statements)

References 8 publications

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“…Jehovah's Whitness) [ 28 ]. A recently published study by Berg et al [ 30 ▪ ] in 2023 collected data from a period of nine years at a teaching hospital in London and demonstrates the beneficial use of cell salvage in obstetric Jehovah‘s Witness women in the peripartum period.…”

Section: When Should Cell Salvage In Obstetrics Be Used?mentioning

confidence: 99%

Current concepts in the use of cell salvage in obstetrics

Neef,

Meybohm,

Zacharowski

et al. 2024

Current Opinion in Anaesthesiology

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Purpose of review The worldwide leading cause of maternal death is severe maternal hemorrhage. Maternal hemorrhage can be profound leading to an entire loss of blood volume. In the past two decades, Patient blood management has evolved to improve patient's care and safety. In surgeries with increased blood loss exceeding 500 ml, the use of cell salvage is strongly recommended in order to preserve the patient‘s own blood volume and to minimize the need for allogeneic red blood cell (RBC) transfusion. In this review, recent evidence and controversies of the use of cell salvage in obstetrics are discussed. Recent findings Numerous medical societies as well as national and international guidelines recommend the use of cell salvage during maternal hemorrhage. Summary Intraoperative cell salvage is a strategy to maintain the patient‘s own blood volume and decrease the need for allogeneic RBC transfusion. Historically, cell salvage has been avoided in the obstetric population due to concerns of iatrogenic amniotic fluid embolism (AFE) or induction of maternal alloimmunization. However, no definite case of AFE has been reported so far. Cell salvage is strongly recommended and cost-effective in patients with predictably high rates of blood loss and RBC transfusion, such as women with placenta accreta spectrum disorder. However, in order to ensure sufficient practical experience in a multiprofessional obstetric setting, liberal use of cell salvage appears advisable.

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Section: When Should Cell Salvage In Obstetrics Be Used?mentioning

confidence: 99%

Current concepts in the use of cell salvage in obstetrics

Neef,

Meybohm,

Zacharowski

et al. 2024

Current Opinion in Anaesthesiology

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“…No maternal deaths or admissions to the adult intensive care unit was found in a London study with 136 pregnant JW. 5 In Japan, no maternal deaths was found amongst the 95 deliveries from JW women. 6 The rise in the number of JW deliveries re ected the need of increasing advocacy and strategies to manage those who refuse blood transfusion.…”

Section: Introductionmentioning

confidence: 98%

Pregnancy outcomes of Jehovah’s Witnesses: case series over fifteen years in a tertiary teaching hospital

Ng,

Seto,

Cheung

2023

Preprint

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Background More than 5000 Jehovah’s Witnesses resided in Hong Kong. Higher morbidity and mortality rates in pregnancy were associated with this specific group of women than the general population. We aim to assess the obstetric and neonatal outcomes of Jehovah’s Witnesses (JW) mothers in a teaching hospital and to evaluate the acceptance rate of blood fractions and blood transfusion alternatives. Methods This is a retrospective case-control study. Women who delivered from 1st January 2005 to 31st December 2020 were analysed from the electronic Clinical Data Analysis and Reporting System (CDARS). Patients who identified themselves as JW were reviewed. The immediate next age-matched non-JW patient in the antenatal care booking register was recruited as control. Results There were 83 JW women identified within the study period. 35 delivered overseas or in the private sector, leaving 48 women for analysis. 8 (16.7%) accepted blood transfusion; 11 (22.9%) accepted some minor fractions, 29 (60.4 %) refused all blood components. 42 (87.5%) had consultant review and anaesthesiologist consultation before delivery with confirmation of their advanced directives. JW mothers had similar haemoglobin levels to controls at different time points – at booking, third trimester, delivery and the postnatal period (p=0.53-0.857). Pregnant JW were more likely to receive iron supplements in the antenatal period (p=0.006) compared with age-matched control. In terms of obstetrics outcome, there was no difference in mode of delivery compared with control. 30 (62.5%) had normal vaginal deliveries, 4 (8.3 %) had instrumental births and 14 (29.1%) had Caesarean births in JW arm. There was no increase in blood loss at delivery for JW mothers (p=0.19). Neonatal outcome in terms of mean birthweight (3266 grams vs 3041 grams, p=0.188) and 5-min Apgar score (9.8 vs 9.9, p=0.448) were comparable between JW and non-JW group. There were no maternal deaths, no hysterectomy and no admissions to the adult intensive care unit in either arms. Conclusion Pregnant JW who received optimised obstetric care had similar outcomes to controls who were non-JW. The risk of morbidity could be mitigated with precautions and JW mothers should not be discriminated on the choice of blood product refusal.

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“…Natural blood has a limited preservation period (< 42 d), requires special storage and transportation conditions [ 32 ], and is susceptible to damage and adverse reactions when infused [ 33 , 34 ]. Natural blood transfusion also carriers risk of infectious diseases, requires associated, time-consuming, cross-matching [ 35 , 36 ] and may conflict with religious beliefs [ 37 , 38 ]. Therefore, blood substitutes that can fully and completely or partially replace the oxygen-carrying functions of RBCs have emerged.…”

Section: Introductionmentioning

confidence: 99%

Nanomaterial-related hemoglobin-based oxygen carriers, with emphasis on liposome and nano-capsules, for biomedical applications: current status and future perspectives

Zhu,

Wang,

Xiao

et al. 2024

J Nanobiotechnol

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Oxygen is necessary for life and plays a key pivotal in maintaining normal physiological functions and treat of diseases. Hemoglobin-based oxygen carriers (HBOCs) have been studied and developed as a replacement for red blood cells (RBCs) in oxygen transport due to their similar oxygen-carrying capacities. However, applications of HBOCs are hindered by vasoactivity, oxidative toxicity, and a relatively short circulatory half-life. With advancements in nanotechnology, Hb encapsulation, absorption, bioconjugation, entrapment, and attachment to nanomaterials have been used to prepare nanomaterial-related HBOCs to address these challenges and pend their application in several biomedical and therapeutic contexts. This review focuses on the progress of this class of nanomaterial-related HBOCs in the fields of hemorrhagic shock, ischemic stroke, cancer, and wound healing, and speculates on future research directions. The advancements in nanomaterial-related HBOCs are expected to lead significant breakthroughs in blood substitutes, enabling their widespread use in the treatment of clinical diseases. Graphical Abstract

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Obstetric outcomes in Jehovah’s Witnesses: case series over nine years in a London teaching hospital

Cited by 5 publications

References 8 publications

Current concepts in the use of cell salvage in obstetrics

Current concepts in the use of cell salvage in obstetrics

Pregnancy outcomes of Jehovah’s Witnesses: case series over fifteen years in a tertiary teaching hospital

Nanomaterial-related hemoglobin-based oxygen carriers, with emphasis on liposome and nano-capsules, for biomedical applications: current status and future perspectives

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