Abstract

BACKGROUND
The management of a patient refusing blood transfusion who subsequently experiences a severe postpartum hemorrhage is a particular clinical challenge.
CASE
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.
CONCLUSION
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

Arab TS, Al-Wazzan AB, Maslow K

Institution

Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB.

Source

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC 32:10 2010 Oct pg 984-7

MeSH

Adult
Antifibrinolytic Agents
Factor VIIa
Female
Fibrin Tissue Adhesive
Hemostatics
Humans
Hysterectomy
Jehovah's Witnesses
Postpartum Hemorrhage
Pregnancy
Recombinant Proteins
Tranexamic Acid
Uterine Artery

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

21176309