Transfusion Alternatives for Pregnant Women
Winter 2002
The Center for Bloodless Medicine & Surgery
at Pennsylvania Hospital offers expectant mothers
alternative options to blood transfusions. 1
in 100 women will need a blood transfusion during
delivery. Women who are at a higher risk for
needing a blood transfusion include:
- those who have had a prior cesarean section
- women with a history of bleeding
- those with a past history of multiple gestation
- women who have an abnormally placed placenta
The need for a blood transfusion poses a special
dilemma for women who are Jehovah Witnesses or
for those who are unwilling to accept major blood
components. Death from hemorrhage is 10 times
higher in patients who refuse blood components
than the general population.
Pregnant women, who prefer not to receive blood
components during delivery, need to advise their
health care provider of their preference as early
as possible. If unexpected bleeding is encountered,
a delay in management can be life threatening
and may account for the difference in the death
rate rather than the lack of blood transfusion.
The Center for Bloodless Medicine & Surgery
at Pennsylvania Hospital carefully evaluates
all high-risk pregnant women before delivery.
Anemia during pregnancy is very common and occurs
in as many as 25% of all pregnant women. A major
cause of anemia is from iron deficiency despite
taking prenatal vitamins. To prepare women for
delivery, we administer iron and a growth factor
called erythropoietin intravenously. Erythropoietin
contains a small amount of albumin and is a matter
of personal choice for Jehovah’s Witnesses.
This combination naturally enhances the production
of red blood cells and in many cases corrects
the anemia. Blood loss at delivery is very poorly
tolerated in anyone who is anemic and may also
compromise postpartum healing.
In a hospital that is prepared to handle the
Jehovah’s Witness patient, there are many
treatments that can quickly be provided if unexpected
hemorrhaging occurs. Obstetrical hemorrhaging
occurs in about 3% of all deliveries. The first
step is to evaluate the woman undergoing labor
and delivery carefully for any early signs of
blood loss or instability. If blood loss is encountered,
there are drugs that can be used to help the
contraction of the uterus, which stops blood
flow after delivery of the baby. There are also
surgical interventions to ligate, or tie off
arteries, so that the blood loss is stopped.
A hysterectomy is considered only if blood loss
can not be stopped.
Other methods are also utilized to help conserve
blood such as cell salvage. This is a procedure
where the blood that is shed is re-filtered and
re-circulated back to the mother in a continuous
circulation. Salvaged blood is a matter of personal
choice for Jehovah’s Witnesses.
This procedure is still considered a controversial
procedure, but current data proves that this
is both a safe and effective method of returning
blood to the maternal circulation. Other medications
are initiated to enhance the clotting ability
of the mother as well as stimulate red blood
cell production.
The combination of educated and informed expectant
mothers and a team of health care providers with
expertise in bloodless management should result
in a safe pregnancy, labor, and delivery as well
as a beautiful experience for mother, baby, and
family. To learn more about services available
for expectant mothers at the Center for Bloodless
Medicine & Surgery at Pennsylvania Hospital,
call 1-800-789-PENN (7366).
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