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FIbrin Glue Soaked Gauze Bandages as a Solution to Refractory Postpartum Hemorrhage in a Jehovah's Witness
Abstract Number: T-50
Abstract Type: Case Report/Case Series
Peripartum hemorrhage represents the most significant cause of maternal morbidity worldwide. Postpartum hemorrhage is responsible for one maternal death every four minutes. Given the prevalence of Jehovah’s Witnesses in the United States (1.2 million in 2011), it is not uncommon to be challenged with treating a hemorrhaging patient who refuses blood products. Here a case is presented of postpartum hemorrhage in a Jehovah’s Witness that was refractory to standard treatment.
A 34 year old G5P3 Jehovah’s Witness patient presented to the emergency department complaining of leaking fluid and vaginal spotting. The patient was found to be fully dilated and had bulging membranes. The patient was admitted for observation and refused all blood products except fibrin. She developed chorioamnionitis and progressed to a vaginal delivery on hospital day two. Immediate postpartum hemorrhage was noted and the patient received misoprostol, hemabate, methergine, and oxytocin while the uterus was manually evacuated. Sharp curettage removed retained placenta and the patient was taken to the operating room for exam under anesthesia.
The patient underwent rapid sequence and her airway was secured. An intrauterine balloon catheter was placed but did not provide hemorrhage control. An intraoperative hematocrit was checked and noted to be 17%. The patient was given aminocaproic acid and volume expanders while further treatment options were reviewed. The patient was determined to be too hemodynamically unstable for hysterectomy. The patient’s blood consent was again reviewed and it was decided to pack the uterus with gauze bandages soaked with fibrin glue under ultrasound guidance. Hemorrhage control was obtained and the patient was transported to the ICU for observation.
The patient was started on erythropoietin injections and the gauze was slowly removed over four days. The patient’s hematocrit had a nadir of 16% on hospital day four and recovered to 22% by discharge on hospital day nine.
This case represents a clinical scenario in which difficulty arose in controlling postpartum hemorrhage in a Jehovah’s Witness. The bleeding was refractory to standard treatment options and the patient was too unstable for definitive control by hysterectomy. This case highlights the necessity of developing detailed blood consents for Jehovah’s Witness patients and ensuring all care providers are aware of the patient’s desires. Through good communication and creative problem solving, a clinical scenario fraught with high maternal mortality was successfully navigated and resulted in a positive outcome.
1.“ACOG Practice Bulletin: Clinical Management Guidelines for Obstetrician-Gynecologists Number 76, October 2006: Postpartum Hemorrhage.” Obstet Gynecol. 2006 Oct; 108(4): 1039-47.
2.2011 Report of Jehovah’s Witnesses Worldwide. (2012) Retrieved January 26, 2012, from www.watchtower.org/e/statistics/worldwide_report.htm