Archives of Gynecology and Obstetrics

, Volume 279, Issue 4, pp 469–472 | Cite as

Lessons learned from the outcome of bloodless emergency laparotomies on Jehovah’s Witness women presenting in the extremis with ruptured uterus

  • B. Chigbu
  • S. Onwere
  • C. Kamanu
  • C. Aluka
  • O. Okoro
  • P. Feyi-Waboso
  • C. Onichakwe
Original Article

Abstract

Objective

We compared the outcomes of bloodless emergency laparotomies for uterine rupture in twenty Jehovah’s Witness (JW) women who were in a state of haemorrhagic shock with 45 other women who received blood transfusion.

Methods

The case records of twenty Jehovah’s Witness patients, who underwent bloodless emergency laparotomies for ruptured uterus complicated by haemorrhagic shock between 1 January 2000 and 31 December 2006 were reviewed. We also reviewed the case records of 45 other patients who underwent similar surgical procedures for similar indications and in whom blood was transfused. The outcome variables compared were maternal deaths, infectious morbidity, acute respiratory distress syndrome, disseminated intravascular coagulation, length of post laparotomy ventilatory support, and length of postpartum hospitalization.

Results

Demographic and obstetric characteristics were similar in both groups. Seventeen out of the twenty Jehovah’s Witness patients who refused blood transfusion survived the laparotomies and were discharged home in good condition. Three died of peritonitis. Six out of the 45 patients who received blood transfusion also died of peritonitis and one died of disseminated intravascular coagulopathy. The average duration of post partum hospitalization was 8 days in the group of patients transfused and 7 days in the group not transfused. Disseminated intravascular coagulation occurred post partum in two of the patients transfused. No case of acute respiratory distress syndrome or amniotic fluid embolism was identified in either group.

Conclusion

Patients who are in haemorrhagic shock from ruptured uterus and refuse blood transfusion can still be salvaged in a low resource setting. The study adds evidence that major operative procedures can be carried out on Jehovah’s Witness patients without blood transfusions or blood products.

Keywords

Bloodless surgery Ruptured uterus Jehovah’s Witness patients Haemorrhagic shock 

References

  1. 1.
    de Castro RM (1999) Bloodless surgery: establishment of a program for the special medical needs of the Jehovah’s Witness community—the gynecologic surgery experience at a community hospital. Am J Obstet Gynecol 180:491–498. doi:10.1016/S0002-9378(99)70044-X CrossRefGoogle Scholar
  2. 2.
    Thomas JM (1994) The worldwide need for education in nonblood management in obstetrics and gynaecology. J SOGC 16:1483–1487Google Scholar
  3. 3.
    (2007) Service Year Report of Jehovah’s Witnesses Worldwide. Km08 02-E Nig Vol. 61, No.2. Published by Watchtower Bible and Tract SocietyGoogle Scholar
  4. 4.
    Maness CP, Russell SM, Altonji P, Allmendinger P (1998) Bloodless medicine and surgery. AORN J 144–152. 10.1016/S0001-2092(06)63195-5
  5. 5.
    Sarteschi LM, Pietrabissa A, Boggi U, Biancofiore G, Sagripanit A, Mosca F (2001) Minimal blood utilization. Int Med Clin Lab 9:19–29Google Scholar
  6. 6.
    Smith MI (1997) Ethical perspectives on Jehovah’s Witnesses’ refusal of blood. Cleve Clin J Med 64(9):475–481PubMedGoogle Scholar
  7. 7.
    Spence RK, Costabile JP, Young GS, Norcross ED, Alexander JB, Pello MJ et al (1992) Is hemoglobin level alone a reliable predictor of outcome in the severely anemic surgical patient? Am Surg 58:92–95PubMedGoogle Scholar
  8. 8.
    Atabek U, Spence RK, Pello M, Alexander J, Camishion R (1992) Pancreaticoduodenectomy without homologous blood transfusion in an anemic Jehovah’s Witness. Arch Surg 127:349–351PubMedGoogle Scholar
  9. 9.
    Marsh JCW, Elebate MO, Bevan DH (2006) Special circumstances: Jehovah’s Witnesses, those who refuse blood transfusion and/or consent. In: B-Lynch C, Keith LG, Lalonde AN, Karoshi M (eds) A Textbook of POSTPARTUM HEMORRHAGE (a comprehensive guide to evaluation, management and surgical intervention). Sapiens Publishing, United Kingdom, pp 147–154Google Scholar
  10. 10.
    Ozawa S, Shander A, Ochani TD (2001) A Practical Approach to Achieving Bloodless Surgery. AORN J 74:34–47. doi:10.1016/S0001-2092(06)61116-2 PubMedCrossRefGoogle Scholar
  11. 11.
    Mann MC, Votto J, Kambe J, McNamee MJ (1992) Management of the severely anemic patient who refuses transfusion: lessons learned during the care of a Jehovah’s Witness. Ann Intern Med 117:1042–1048PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • B. Chigbu
    • 1
  • S. Onwere
    • 1
  • C. Kamanu
    • 1
  • C. Aluka
    • 1
  • O. Okoro
    • 1
  • P. Feyi-Waboso
    • 1
  • C. Onichakwe
    • 1
  1. 1.Department of Obstetrics and GynaecologyAbia State University Teaching HospitalAbaNigeria

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