title: Secondary abdominal pregnancy in a Jehovah's Witness.
abstract: A 35-year-old woman, gravida 2, para 1, aborta 0, arrived at our emergency department with abdominal pain of more than 2 weeks' duration. Diagnostic pelvic ultrasonography confirmed a 16-week intra-abdominal pregnancy. Hemoglobin level was 6.9 mg/dL, and hematocrit value was 20.1%. The patient refused blood transfusion on religious grounds. Laparotomy revealed 2,000 mL of blood in the abdomen and a live fetus, with the placenta attached to the omentum and the serosal surface of the right fallopian tube. Postoperative hemoglobin level was 2.8 mg/dL. The patient was transferred to another facility for hyperbaric oxygen therapy, where she subsequently died. Abdominal pregnancy is rare, but has high fetal and maternal mortality rates. Our patient's case was complicated, since she was a Jehovah's Witness and refused lifesaving treatment on religious grounds. Serious medical decisions were made, while respecting the autonomy of the patient.
authors.affiliation: Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center-Tulsa 74104, USA.
authors.forename: H A
authors.initials: HA
authors.lastname: Shaw
authors.forename: E
authors.initials: E
authors.lastname: Ezenwa
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis; D000328:Adult; D001803:Blood Transfusion; D002835:Christianity; D017809:Fatal Outcome; D005260:Female; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D006931:Hyperbaric Oxygenation; D007813:Laparotomy; D011247:Pregnancy; D011269:Pregnancy, Abdominal / Q000097:blood / Q000000981:diagnostic imaging* / Q000601:surgery; D012068:Religion and Medicine; D016312:Treatment Refusal; D016216:Ultrasonography, Prenatal
chemical_list: D006454:Hemoglobins