Murphy Niamh C, Hayes Niamh E, Ainle Fionnuala B Ní, Flood Karen M
Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland.
J Med Case Rep. 2014 Sep 19;8:312. doi: 10.1186/1752-1947-8-312.
The management of emergencies in Jehovah's Witnesses presents several challenges to obstetricians and gynaecologists. We present two cases of ectopic pregnancies in Jehovah's Witnesses recently managed in our institution. This is the first case review series of its kind that we could identify. We feel it is of clinical importance for all physicians caring for Jehovah's Witnesses.
The first patient was a 28-year-old Caucasian Irish woman who presented in a state of collapse and a ruptured ectopic pregnancy was suspected. She refused treatment and took her own discharge against the advice of senior hospital staff. She re-presented to our Emergency Room 6 hours later in hypovolaemic shock. She ultimately consented to blood products including plasma and platelets and underwent laparoscopic left-sided salpingectomy. This consent was queried postoperatively by her next-of-kin but the validity of her consent was clarified by the hospital legal team.The second patient was a 35-year-old Nigerian woman who presented to our Emergency Room with a 2-week history of intermittent vaginal bleeding and abdominal pain with a haemoglobin of 5.4 g/dL. An ectopic pregnancy was diagnosed following assessment. She refused all blood products and underwent right-sided salpingectomy. Intravenous tranexamic acid was administered and cell salvage employed intraoperatively.
We feel that this case review series emphasises the importance of appropriate management of Jehovah's Witnesses in our units. In both of the above cases, these women were in potentially life-threatening situations. Advances in haematology and pharmaceutical therapy contributed to their survival. We welcome these advances in the treatment of this patient population.
耶和华见证人的急症处理给妇产科医生带来了诸多挑战。我们介绍两例近期在我院处理的耶和华见证人异位妊娠病例。这是我们所能找到的首例此类病例回顾系列。我们认为这对所有照料耶和华见证人的医生具有临床重要性。
首例患者是一名28岁的白种爱尔兰女性，就诊时处于休克状态，怀疑为异位妊娠破裂。她拒绝治疗，不顾医院高级 staff 的建议自行出院。6小时后她再次来到我们的急诊室，处于低血容量休克状态。她最终同意接受包括血浆和血小板在内的血液制品，并接受了腹腔镜左侧输卵管切除术。术后她的近亲对这一同意表示质疑，但医院法律团队澄清了她同意的有效性。第二例患者是一名35岁的尼日利亚女性，因间歇性阴道出血和腹痛2周前来我们的急诊室，血红蛋白为5.4 g/dL。经评估后诊断为异位妊娠。她拒绝所有血液制品，接受了右侧输卵管切除术。术中给予静脉注射氨甲环酸并采用了细胞回收技术。
我们认为这个病例回顾系列强调了在我们科室对耶和华见证人进行适当管理的重要性。在上述两例病例中，这些女性都处于潜在的危及生命的状况。血液学和药物治疗的进展促成了她们的存活。我们欢迎在治疗这一患者群体方面取得的这些进展。
