Conservative Management of Placenta Previa Percreta in a Jehovah's Witness.

Sharon Grant · #1 (**permalink**) 06-14-2005, 11:47 PM

Obstet Gynecol. 2005 May;105(5):1247-50.
http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15863598

Conservative Management of Placenta Previa Percreta in a Jehovah's Witness.

Weinstein A, Chandra P, Schiavello H, Fleischer A.

Department of Obstetrics and Gynecology, Wyckoff Heights Medical Center, Brooklyn, New York; and the Departments of Obstetrics and Gynecology and Vascular/Interventional Radiology, Long Island Jewish Medical Center, New Hyde Park, New York.

BACKGROUND: Hemorrhage is a serious threat with placenta accreta, often requiring aggressive operative intervention by hysterectomy and resuscitative measures with large-volume blood replacement to ensure survival. Refusal to accept transfusion makes management especially difficult. CASE: We report a Jehovah's Witness patient who had 9 previous cesarean deliveries and presented with anemia and placenta previa percreta invading the bladder wall. Management objectives were to enhance the patient's status, using erythropoietin and autologous transfusion, and to minimize the chance of hemorrhage by prophylactic uterine artery embolization. The placenta was left in situ after the delivery with no untoward consequences. Methotrexate was held in readiness, but was not required as adjuvant therapy. CONCLUSION: Effective care of such patients requires close collaborative team effort and advanced planning to ensure a good outcome.

PMID: 15863598 [PubMed - in process]

glcolon · #2 (**permalink**) 02-07-2006, 07:05 AM

In this case: ''Management objectives were to enhance the patient's status, using erythropoietin and autologous transfusion, and to minimize the chance of hemorrhage by prophylactic uterine artery embolization.''

What would "autologous transfusion" mean here? Would it be the use of a device like a cell saver, or would it involve transfusion from the patient's own conserved blood?

Thank you

notblood · #3 (**permalink**) 09-10-2007, 06:28 PM

I was wondering as well

you'll need to define autologous transfusion more because use of a stored blood product is as far as I am aware as a baptised Jehovah's Witness this wouldn't be considered to be acceptable

it perhaps depends on as one HLC member put it if the blood is considered 'in play' or not [an expression he coined from football]

please state using medical terms what actually occurred rather than summarising it
[while maintaining patient confidentiality as far as possible]

notblood · #4 (**permalink**) 09-10-2007, 06:30 PM

what do you mean enhance the patients status, surely you're talking about increasing their blood volume, giving them iron and EPO where needed to increase haematocrit as well

why would that require autologous blood transfusion?

jgrossberg · #5 (**permalink**) 09-14-2007, 11:44 PM

QUOTE: "Management objectives were to enhance the patient's status, using erythropoietin and autologous transfusion, and to minimize the chance of hemorrhage by prophylactic uterine artery embolization."

I wonder if this research abstract is simply stating the management objectives (i.e., the plan of care), but what actually was implemented may not have included the "autologous transfusion" option...?

I haven't read the actual text of the research, but I plan to do this to determine exactly what took place in this patient's case.

It is correct that an autologous transfusion (once the blood has been taken out and stored) would indeed not be acceptable to one of Jehovah's Witnesses. Time to read the entire article, if I can get the full text.

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Conservative Management of Placenta Previa Percreta in a Jehovah's Witness.

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