Oral Presentation Society of Obstetric Medicine of Australia and New Zealand ASM 2015

Caring for pregnant women for whom transfusion is not an option. (#24)

Giselle Kidson-Gerber 1 , Ian Kerridge 2 , Shannon Farmer 3 , Cameron Stewart 4 , Helen Savoia 5 , Daniel Challis 6
  1. Prince of Wales Hospital, Royal Hospital for Women, Randwick, NSW, Australia
  2. Centre for Values, Ethics and the Law in Medicine, Sydney Medical School, University of Sydney, , Sydney, Australia.
  3. School of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Australia.
  4. Sydney Law School, University of Sydney, Sydney, AUSTRALIA.
  5. Royal Children’s Hospital , Melbourne
  6. NSW Pregnancy and Newborn Services Network, , Sydney, Australia.

Postpartum haemorrhage 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, with substandard clinical care contributing to these poorer outcomes. This oral presentation 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, will be discussed.