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Intraoperative bloodless management of a Jehovah’s Witness with HELLP syndrome undergoing urgent cesarean section
Abstract Number: F4C-9
Abstract Type: Case Report/Case Series
A 33yo G1P0 Jehovah’s Witness with history of mild asthma, GERD, and morbid obesity at 33w1d presented to labor and delivery with a 12 hour history of abdominal pain, back pain, and headache. BP was noted to be 185/114 with BP the day prior in the office noted to be normal. Lab work at the time showed elevated liver enzymes and thrombocytopenia with platelets of 29,000 prompting diagnosis of preeclampsia with severe features and HELLP syndrome. The patient refused all blood products and blood product fractions inclusive of albumin, human derived clotting factors, and autologous platelet gel. Although it was understood that Dutch Jehovah’s Witnesses were at 130 times increased risk for maternal death because of severe hemorrhage, an urgent cesarean section was deemed necessary and performed under general anesthesia. There was prophylactic use of multiple uterotonics, prophylactic use of desmopressin, continuous circuit cell salvage, and tranexamic acid. Estimated blood loss at the end of the case was lower than expected at 600mL and both newborn and mother were discharged postoperatively within a week. This case highlights the unique challenges of caring for high hemorrhage risk parturient without transfusion, utilization for newer technologies (i.e. cell salvage)  and use of novel and newer medications such as transexamic acid for prophylaxis against hemorrhage.
 Wolfswinkel, M. V., Zwart, J., Schutte, J., Duvekot, J., Pel, M., & Roosmalen, J. V. (2009). Maternal mortality and serious maternal morbidity in Jehovah’s witnesses in the Netherlands. BJOG: An International Journal of Obstetrics & Gynaecology,116(8).
 Catling, S., & Joels, L. (2005). Cell salvage in obstetrics: the time has come. BJOG: An International Journal of Obstetrics and Gynaecology,112(2), 131-132.
 Shakur, H. et. al. (2017). Effect of Early Tranexamic Acid Administration on Mortality, Hysterectomy, and Other Morbidities in Women With Post-Partum Haemorrhage (WOMAN). Obstetrical & Gynecological Survey,72(9), 525-526.