Are women who are Jehovahʹs Witnesses at risk of maternal death?

Objective: The purpose of this study was to determine the rates of obstetric hemorrhage and maternal mortality in women who are Jehovahʹs Witnesses and to evaluate a protocol that uses erythropoietin to optimize the red blood cell mass before delivery. Study Design: Obstetric outcomes were described for all of the women who were Jehovahʹs Witnesses and who delivered at Mount Sinai Medical Center during an 11-year period. The risk of maternal death was compared with our general obstetric population during this interval. Results: A total of 332 women who were Jehovahʹs Witnesses had 391 deliveries. An obstetric hemorrhage was experienced in 6% of this population. There were 2 maternal deaths among the women who were Jehovahʹs Witnesses, for a rate of 512 maternal deaths per 100,000 live births versus 12 maternal deaths per 100,000 live births (risk ratio, 44; 95% CI, 9-211). Erythropoietin was associated with a nonsignificant increase in hematocrit level. Conclusion: Women who are Jehovahʹs Witnesses are at a 44-fold increased risk of maternal death, which is due to obstetric hemorrhage. Patients should be counseled about this risk of death, and obstetric hemorrhage should be aggressively treated, including a rapid decision to proceed to hysterectomy when indicated. (Am J Obstet Gynecol 2001;185: 893-5.)