title: Management of the Jehovah's Witness in Obstetrics and Gynecology: A Comprehensive Medical, Ethical, and Legal Approach.
abstract: OBJECTIVE
  Obstetricians and gynecologists frequently deal with hemorrhage so they should be familiar with management of patients who refuse blood transfusion. Although there are some reports in the literature about management of Jehovah's Witness patients in obstetrics and gynecology, most of them are case reports, and a comprehensive review about these patients including ethicolegal perspective is lacking.
  
  
  OBJECTIVE
  This review outlines the medical, ethical, and legal implications of management of Jehovah's Witness patients in obstetrical and gynecological settings.
  
  
  METHODS
  A search of published literature using PubMed, Ovid Medline, EMBASE, and Cochrane databases was conducted about physiology of oxygen delivery and response to tissue hypoxia, mortality rates at certain hemoglobin levels, medical management options for anemic patients who refuse blood transfusion, and ethical/legal considerations in Jehovah's Witness patients.
  
  
  RESULTS
  Early diagnosis of anemia and immediate initiation of therapy are essential in patients who refuse blood transfusion. Medical management options include iron supplementation and erythropoietin. There are also some promising therapies that are in development such as antihepcidin antibodies and hemoglobin-based oxygen carriers. Options to decrease blood loss include antifibrinolytics, desmopressin, recombinant factor VII, and factor concentrates. When surgery is the only option, every effort should be made to pursue minimally invasive approaches.
  
  
  CONCLUSIONS
  All obstetricians and gynecologists should be familiar with alternatives and "less invasive" options for patients who refuse blood transfusions.
authors.affiliation: Resident Physician, Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, TX.
authors.forename: Burak
authors.initials: B
authors.lastname: Zeybek
authors.affiliation: Assistant Professor, Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Childress
authors.affiliation: Associate Professor, Department of Obstetrics and Gynecology.
authors.forename: Gokhan S
authors.initials: GS
authors.lastname: Kilic
authors.affiliation: Associate Professor, Department of Obstetrics and Gynecology.
authors.forename: John Y
authors.initials: JY
authors.lastname: Phelps
authors.affiliation: Associate Professor, Department of Obstetrics and Gynecology.
authors.forename: Luis D
authors.initials: LD
authors.lastname: Pacheco
authors.affiliation: Professor, Institute for the Medical Humanities.
authors.forename: Michele A
authors.initials: MA
authors.lastname: Carter
authors.affiliation: Assistant Professor, Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, TX.
authors.forename: Mostafa A
authors.initials: MA
authors.lastname: Borahay
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000188:drug therapy* / Q000517:prevention & control; D001803:Blood Transfusion / Q000941:ethics / Q000331:legislation & jurisprudence; D036861:Delivery, Obstetric / Q000941:ethics; D005260:Female; D006401:Hematologic Agents / Q000627:therapeutic use*; D006470:Hemorrhage / Q000188:drug therapy; D006801:Humans; D033221:Jehovah's Witnesses; D010817:Physician-Patient Relations / Q000941:ethics; D006473:Postpartum Hemorrhage / Q000517:prevention & control; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000188:drug therapy* / Q000517:prevention & control; D016312:Treatment Refusal / Q000941:ethics / Q000331:legislation & jurisprudence
chemical_list: D006401:Hematologic Agents