REVIEW ARTICLE
The Jehovah’s Witness obstetric patient – a literature review
More details
Hide details
1
Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, Poland
Submission date: 2019-08-19
Final revision date: 2019-10-26
Acceptance date: 2019-11-23
Publication date: 2019-12-22
Anaesthesiol Intensive Ther 2019;51(5):390-403
KEYWORDS
TOPICS
ABSTRACT
The patient’s right to refuse blood transfusion must be honoured in case of its clear expression. Some special pharmacologic and/or surgical procedures can be useful in a Jehovah Witness (JW) parturient. In case of excess blood loss the maintenance of peripheral tissue oxygenation is crucial. Only a few hospitals have equipment for blood salvage, and alternative oxygen carriers have potentially lethal side effects. Findings suggest that obstetric facilities should develop special algorithms of management in the case of the JW obstetric patient, with written declaration of which elements of blood are not acceptable for the patient, early diagnosis and intensive treatment of anaemia in pregnancy, administration of antifibrinolytic agents before surgery, use of electric surgical tools to restore haemostasis, early detection and aggressive treatment of excessive blood loss and, last but not least, close cooperation between obstetricians and anaesthesiologists, including sharing the information about the patient’s refusal of blood transfusion.
REFERENCES (51)
1.
Husarova V, Donelly G, Doolan A, Garstka M, Ni Ainle F, McCaul C. Preferences of Jehovah’s Witness regarding haematological supports in an obstetric setting: experience of a single university teaching hospital. Int J Obstet Anaesth 2016; 25: 53-57. doi: 10.1016/j.ijoa. 2015.09.005.
2.
Hubbard RM, Waters J. Successful resuscitation following massive obstetric haemorrhage in a patient of the Jehovah’s Witness faith: a case report. AA Case Rep 2017; 8: 326-329. doi: 10.1213/XAA. 0000000000000503.
3.
Kidson-Gerber G, Kerridge I, Farmer S, Stewart CL, Savola H, Challis D. Caring for pregnant women for whom transfusion is not an option. A national review to assist in patient care. Aust New Zealan J Obstet Gynaecol 2016; 56: 127-136. doi: 10.1111/ajo.12420.
4.
Zeybek B, Childress A, Kilic GS, et al. Management of the Jehovah’s Witness in obstetrics and gynaecology: a comprehensive medical, ethical and legal approach. Obstet Gynecol Surv 2016; 71: 488-500. doi.org/10.1097/ OGX.0000000000000343.
5.
Gyamfi C, Gyamfi MM, Berkovitz RL. Ethical and medicolegal considerations in the obstetric care of a Jehovah’s Witness. Obstet Gynecol 2003; 102: 173-180. doi:10.1016/s0029-7844(03)00236-9.
6.
Russo RM, Girda E, Kennedy V, Humphries MD. Two lives, one REBOA: haemorrhage control for urgent caesarean hysterectomy in a Jehovah’s Witness with placenta percreta. J Trauma Acute Care Surg 2017; 83: 551-553. doi: 10.1097/TA.0000000000001602.
7.
Rajtar M. Bioethics and religious bodies: refusal of blood transfusions in Germany. Soc Sci Med 2013; 98: 271-277. doi: 10.1016/j.socscimed. 2013.02.043.
8.
Rollins KE, Contractor U, Inumerable R, Lobo DN. Major abdominal surgery in Jehovah’s Witnesses. Ann R Coll Surg Engl 2016; 98: 523-537. doi:10.1308/rcsann.2016.0210.
9.
Curtice M, James L. Faith, ethics and Section 63 of the Mental Health Act 1983. BJPsych Bull 2016; 40: 77-81. doi: 10.1192/pb.bp.114. 050492.
10.
Cole JL, McLeod ND. Administration of four-factor prothrombin complex concentrate for a life-threatening bleed in a Jehovah’s Witness patient. Blood Coagul Fibrynolysis 2018; 29: 120-122. doi: 10.1097/MBC.0000000000000664.
11.
Gohel MS, Bulbulia RA, Slim FJ, Poskitt KR, Whyman MR. How to approach major surgery where patients refuse blood transfusion (including Jehovah’s Witnesses). Ann R Coll Surg Engl 2005; 87: 3-14. 10.1308/1478708051414.
12.
Ringnes HK, Hegstad H. Refusal of medical blood transfusions among Jehovah’s Witnesses: emotion regulation of the dissonance of saving and sacrificing life. J Relig Health 2016; 55: 1672-1687. doi: 10.1007/s10943-016-0236-5.
15.
Silva L de A, de Carli D, Cangiani LM, Gonçalves Filho JB, da Silva IF. Epidural blood patch in Jehovah’s Witness: two cases report. Rev Bras Anestesiol 2003; 53: 633-639.
16.
Habler O. Focused update: perioperative management of Jehovah’s Witness patients in relation to their refusal of allogeneic blood transfusion; www.nataonline.com.
18.
Scharman CD, Burger D, Shatzel JJ, Kim E, DeLoughery TG. Treatment of individuals who cannot receive blood products for religious or other reasons. Am J Hematol 2017; 92: 1370-1381. doi: 10.1002/ajh.24889.
19.
Trivino R. Religious minorities and justice in healthcare. The current situation in Spain. Camb Q Healthic Ethics 2013; 22: 277-283.
20.
Gutierrez-Vega R, Gallegos-Garza AC, Fajardo-Dolci G. Blood transfusion in Jehovah’s Witnesses, a dilemma in medicine? Rev Med Hosp Gen Mex 2014; 77: 195-198.
22.
Petrini C. Ethical and legal aspects of refusal of blood transfusions by Jehovah’s Witnesses, with particular reference to Italy. Blood Transfus 2014; 12 (Suppl 1): s395-s401.
23.
Sauer CW, Krishelle L. Attempting to honor beliefs of Jehovah’s Witnesses at the edge of viability in an infant born at 23 weeks’ gestational age. Am J Case Rep 2016; 17: 375-378. doi: 10.12659/AJCR.898002.
24.
Bester JC, Smith M, Griggins C. A Jehovah’s Witness adolescent in the labor and delivery unit: should patient and parental refusals of blood transfusions for adolescents be honoured? Narrat Inq Bioeth 2017; 7: 97-106. doi: 10.1353/nib.2017.0022.
25.
Żelichowski A. Brak zgody pacjenta na transfuzję krwi ze względów religijnych – aspekt prawny. Medycyna Praktyczna 2010/02;
https://prawo.mp.pl/publikacje...- na-transfuzje-krwi-ze-wzgledow-religijnych-aspekt-prawny.html.
26.
McDonald D, Managh R. Jehovah’s Witness forced to have life-saving transfusion;
https://www.independent.ie/lif... health/jehovahs-witness-forced-to-have-lifesaving-transfusion-26366172.html.
27.
Zając P. Odpowiedzialność lekarza za przeprowadzenie zabiegu leczniczego związanego z transfuzją krwi bez uzyskania zgody Świadka Jehowy;
https://www.researchgate.net/p....
28.
Belaouchi M, Romero E, Mazzinan G, et al. Management of massive bleeding in a Jehovah’s Witness obstetric patient: the overwhelming importance of a pre-established multidisciplinary protocol. Blood Transfus 2016; 14: 541-544. doi: 10.2450/2016.0229-15.
29.
Patients Who Decline Blood Products. Guidance document. American College of Obstetricians and Gynecologists. Revised February 2019.
30.
Bergman J. JW socioeconomic status review. A Major Demographic Study of American Jehovah’s Witnesses Documenting their Low Educational, Occupational and Income Status; Investigator 86, 2002 September;
http://ed5015.tripod.com/ JwSocioeconomic86.htm.
32.
Jehovah’s Witnesses’ educational and professional deficit; an online publication of Baylor Institute for Studies of Religion; Baylor University; Volume 32 No. 5;
http://www.religionwatch.com.
34.
Takashima AKK, Sakae TM, Takashima AK, Lima BJ, Benedetti RH. Ethical and legal duty of anaesthesiologists regarding Jehovah’s Witness patient: care protocol. Rev Bras Anaesthesiol 2016; 66: 637-641. doi: 10.1016/j.bjane.2015.03.012.
35.
Obstetric Hemorrhage. Risk Assesment Tables. American College of Obstetricians and Gynecologists. Revised January 2019.
37.
Mavrides E, Allard S, Chandraharan E, et al., on behalf of the Royal College of Obstetricians and Gynaecologists. Prevention and management of postpartum haemorrhage. BJOG 2016; 124: e106-e149.
39.
Updated WHO Recommendation on Tranexamic Acid for the Treatment of Postpartum Haemorrhage; Highlights and Key Messages from the World Health Organization’s 2017 Global Recommendation; October 2017;
https://apps.who.int/ iris/bitstream/handle/10665/259379/WHO-RHR-17.21-eng.pdf;jsessionid=9085BC7919B21E274E0B4 6793312AD1A?sequence=1.
40.
Posluszny JA, Napolitano L. Hemoglobin-based oxygen carrier for traumatic hemorrhagic shock treatment in a Jehovah’s Witness. Arch Trauma Res 2016; 5: e30610. doi: 10.5812/atr.30610.
42.
Esper SA, Waters JH. Intra-operative cell salvage: a fresh look at the indications and contraindications. Blood Transfus 2011; 9: 139-147.
43.
Intraoperative Cell Salvage in Obstetrics; Catherine Smith William Shippam James Brown and Gillian Abir; ATOTW 380 – Intraoperative Cell Salvage in Obstetrics 29th May 2018;
https://www.wfsahq.org.
44.
Mackenzie CF, Morrison C, Jaberi M. Management of hemorrhagic shock when blood is not an option. J Clin Anesth 2008; 20: 538-541. doi: 10.1016/j.jclinane.2008.05.012.
45.
Alayash AI. Blood substitutes: why havent’t we been more successful? Trends Biotechnol 2014; 32: 177-185. doi: 10.3390/biom7010002.
48.
Riveros-Perez E, Kacmar R. Peripartum care of the Jehovah’s Witness patient. Clin Obst Gyn 2017; 60: 394-404. doi: 10.1097/GRF. 0000000000000271.
49.
Milman N. Postpartum anemia II: prevention and treatment. Ann Hematol 2012; 91: 143-154.
50.
Holm Ch. Intravenous iron treatment in the puerperium. Dan Med J 2018; 65: B5471.
51.
Sultan P, Bampoe S, Shah R, et al. Oral vs intravenous iron therapy for postpartum anemia: a systematic review and meta-analysis. Am J Obstet Gynecol 2019; 221: 19-29.e3.