Management strategies and clinical outcomes of obstetric patients who decline allogeneic blood transfusion

Background and Objectives: Providing obstetrical care for patients who decline transfusions can be challenging. We describe methods of coordinated bloodless care and compare outcomes to a similar group of patients who accept transfusions. Materials and Methods: This retrospective analysis included obstetric Jehovah's Witness patients (bloodless group) from 2012 to 2023. We performed cohort matching in a 1:2 ratio with patients who accept transfusion (standard care), based on race, ethnicity, age, gestational age, body mass index and delivery mode (vaginal vs. caesarean section). Methods of blood conservation and clinical outcomes were compared between groups. Results: There were 131 bloodless and 262 standard care deliveries. There were no maternal mortalities in either group, and no difference in morbid events (1.5% of bloodless deliveries vs. 0.8% of standard care deliveries; p = 0.608). Prenatal intravenous iron was given more frequently in the bloodless compared with the standard care group (13.7% vs. 4.6%, p = 0.002). Second-line uterotonics were used more frequently in bloodless compared with standard care deliveries (44.3% vs. 29.0%, p = 0.021). Albumin was also more frequently given in bloodless compared with standard care deliveries (5.3% vs. 1.5%, p = 0.047). Cell salvage was present for 67.3% of the bloodless group but was not utilized for any standard care deliveries (p < 0.001). None of the bloodless patients received a red blood cell transfusion, while 10 standard care deliveries (3.8%) were transfused (p = 0.035). Conclusion: Obstetric patients who decline allogeneic transfusions can be effectively managed with bloodless medicine techniques with acceptable outcomes.