Department of Gynaecology, St. George's Hospital NHS Trust, London, UK.
Blood Transfus. 2012 Oct;10(4):462-70. doi: 10.2450/2012.0105-11. Epub 2012 Jul 4.
Refusal of blood transfusion by Jehovah's Witness (JW) women poses potential problems for obstetrics worldwide as haemorrhage remains a major cause of maternal morbidity and mortality. There is a general consensus that morbidity and mortality rates in association with childbirth and gynaecological interventions are higher in these women than in the general population. We conducted a postal questionnaire survey of current practice among U.K. consultant obstetricians and gynaecologists to establish the practices that could contribute to poor outcomes in these women.
The main variables of interest were: use of a multi-disciplinary approach; the acceptable minimum haemoglobin (Hb) concentration before vaginal delivery and abdominal hysterectomy as low to medium risk scenarios and open myomectomy as a high risk scenario for haemorrhage; Hb concentration thresholds for iron supplementation; and the use of oral iron, intravenous iron, erythropoietin and cell salvage as potential management tools.
The response rate was 28%. Sixty percent of gynaecologists and 85% of obstetricians reported having a protocol for the management of JW women. Forty-six percent of consultants adopt a multi-disciplinary approach which include anaesthetists and haematologists. A Hb concentration of >11-12 g/dL is considered the minimum acceptable level by a majority (47%) prior to normal delivery and by 42% of gynaecologists prior to abdominal hysterectomy. For open myomectomy 28% of gynaecologists prefer a minimum level of 11-12 g/dL but a further 31% of gynaecologists prefer a minimum level of 12-13 g/dL.
A small but substantial proportion of consultants do not have protocols, operate on JW women with low Hb concentrations, do not use a lower Hb concentration threshold for supplementation, and do not adopt a multi-disciplinary approach, all of which could contribute to the reported poor outcomes in these women.
由于耶和华见证会（JW）女性拒绝输血，这给全球的产科带来了潜在的问题，因为出血仍然是产妇发病率和死亡率的主要原因。人们普遍认为，与分娩和妇科干预相关的发病率和死亡率在这些女性中高于一般人群。我们对英国顾问产科医生和妇科医生进行了一项邮寄问卷调查，以确定可能导致这些女性不良结局的实践。
主要关注的变量是：多学科方法的使用；阴道分娩和剖腹子宫切除术的可接受最低血红蛋白（Hb）浓度，作为低至中等风险的情况，以及开腹子宫肌瘤切除术作为出血高风险情况；铁补充的 Hb 浓度阈值；以及口服铁、静脉铁、促红细胞生成素和细胞回收作为潜在管理工具的使用。
回复率为 28%。60%的妇科医生和 85%的产科医生报告说有 JW 女性管理方案。46%的顾问采用多学科方法，包括麻醉师和血液学家。大多数（47%）人认为在正常分娩前，Hb 浓度>11-12g/dL 是可接受的最低水平，42%的妇科医生在剖腹子宫切除术前认为是可接受的最低水平。对于开腹子宫肌瘤切除术，28%的妇科医生更喜欢 11-12g/dL 的最低水平，但另有 31%的妇科医生更喜欢 12-13g/dL 的最低水平。
一小部分但相当一部分顾问没有方案，在 Hb 浓度较低的情况下为 JW 女性做手术，不使用较低的 Hb 浓度阈值进行补充，也不采用多学科方法，所有这些都可能导致这些女性报告的不良结局。
