title: Caring for pregnant women for whom transfusion is not an option. A national review to assist in patient care.
abstract: Postpartum haemorrhage (PPH) is the leading cause of maternal mortality and morbidity globally. Obstetric bleeding can be catastrophic and management is challenging, involving a coordinated multidisciplinary approach, which may include blood products. In settings where blood transfusion is not an option, either because of patient refusal (most commonly in Jehovah Witnesses) or because of unavailability of blood, management becomes even more challenging. Observational studies have demonstrated an association between refusal of blood products in major obstetric haemorrhage and increased morbidity and mortality. This review draws upon evidence in the literature, physiological principles and expert opinion for strategies and guidance to optimise the outcomes of pregnant women in whom blood transfusion is either refused or impossible. The importance of a multidisciplinary antenatal and perinatal management plan, including optimisation of haemoglobin and iron stores pre-delivery, blood loss minimisation, early haemorrhage control and postpartum anaemia treatment, is discussed.
authors.affiliation: Department of Haematology, Prince of Wales Hospital & Royal Hospital for Women, New South Wales, Australia.|University of NSW, Kensington, New South Wales, Australia.|Australian Centre for Perinatal Science, Sydney, New South Wales, Australia.
authors.forename: Giselle
authors.initials: G
authors.lastname: Kidson-Gerber
authors.affiliation: Royal North Shore Hospital, Sydney, New South Wales, Australia.|Centre for Values, Ethics and the Law in Medicine, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Kerridge
authors.affiliation: School of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Western Australia, Australia.|Centre for Population Health Research, Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia.
authors.forename: Shannon
authors.initials: S
authors.lastname: Farmer
authors.affiliation: Sydney Law School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Cameron L
authors.initials: CL
authors.lastname: Stewart
authors.affiliation: Royal Children's Hospital, Melbourne, Sydney, New South Wales, Australia.
authors.forename: Helen
authors.initials: H
authors.lastname: Savoia
authors.affiliation: NSW Pregnancy and Newborn Services Network, Sydney, New South Wales, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Challis
mesh_terms: D000740:Anemia / Q000209:etiology / Q000628:therapy; D001771:Blood Banks / Q000600:supply & distribution*; D001803:Blood Transfusion; D005260:Female; D006801:Humans; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011247:Pregnancy; D011295:Prenatal Care; D018570:Risk Assessment; D016312:Treatment Refusal
keywords: Jehovah's Witness; bloodless medical and surgical procedures; ethics; pregnancy; prenatal care