title: Postpartum hemorrhage in a Jehovah's Witness patient controlled with Tisseel, tranexamic acid, and recombinant factor VIIa.
abstract: BACKGROUND
  The management of a patient refusing blood transfusion who subsequently experiences a severe postpartum hemorrhage is a particular clinical challenge.
  
  
  METHODS
  A 30-year-old nulliparous patient (who was a Jehovah's Witness) had labour induced for post-dates at 41+4 weeks' gestational age after an uncomplicated pregnancy. She delivered by Caesarean section for dystocia and suspected chorioamnionitis, and subsequently developed postpartum hemorrhage that required management with oxytocin, ergometrine, carboprost, uterine artery ligation, and Hayman compression sutures. The patient ultimately required two additional visits to the operating room, culminating in hysterectomy. Use of tranexamic acid, recombinant factor VIIa, and Tisseel was instrumental in halting the ongoing hemorrhage.
  
  
  CONCLUSIONS
  Optimal management of a patient refusing administration of blood products requires a multidisciplinary approach as well as a combination of traditional and novel therapies.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB.
authors.forename: Tarek Samir
authors.initials: TS
authors.lastname: Arab
authors.forename: Ahmad Bakr
authors.initials: AB
authors.lastname: Al-Wazzan
authors.forename: Ken
authors.initials: K
authors.lastname: Maslow
mesh_terms: D000328:Adult; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D015942:Factor VIIa / Q000627:therapeutic use*; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D007044:Hysterectomy; D033221:Jehovah's Witnesses; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011247:Pregnancy; D011994:Recombinant Proteins / Q000627:therapeutic use; D014148:Tranexamic Acid / Q000627:therapeutic use*; D055988:Uterine Artery / Q000601:surgery
chemical_list: D000933:Antifibrinolytic Agents; D015718:Fibrin Tissue Adhesive; D006490:Hemostatics; D011994:Recombinant Proteins; D014148:Tranexamic Acid; D015942:Factor VIIa