BOE Letter on Mothers to be

by JWFreak 41 Replies latest jw friends

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  skeeter1

  I think the Doctors know what they are doing when they try to get pregnant women to accept a blood transfusion!

  Transfusion for Massive Blood Loss

  Presented below is a description of massive blood loss and the inherent problems associated with large volume blood transfusions. Following this is a suggested protocol for guiding management of the patient receiving a massive transfusion for haemorrhage.

  Definition

  Massive transfusion is arbitrarily definied as the replacement of a patient's total blood volume in less than 24 hours, or as the acute administration of more than half the patient's estimated blood volume per hour.

  A

  im of Treatment Complications of Massive Transfusion

  The aim of treatment is the rapid and effective restoration of an adequate blood volume and to maintain blood composition within safe limits with regard to haemostasis, oxygen carrying capacity, oncotic pressure and biochemistry.

  The complications of massive transfusion are those of any blood transfusion plus :

  • Blood Volume Replacement
    The complications of massive transfusion are exacerbated by inadequate or excessive transfusion. Traditionally transfusion of hypovolaemic patients has been directed towards maintaining a haemoglobin concentration of 10g/dl. The use of haemoglobin as the only indicator (or 'transfusion trigger') may result in unnecessary administration of blood products, with their concommittant risks.

    Transfusion requirements should be based on the patient's physiologic needs, defined by their oxygen demand (consumption).

    Oxygen consumption is given by :

    Where CO = Cardiac Output, CaO2 and CvO2 are arterial and venous oxygen content respectively.

    Oxygen delivery is :

    The extraction ratio (ER) is the ratio of oxygen consumption to oxygen delivery, normally around 25%.

    The most appropriate monitor of tissue oxygen supply is the tissue oxygen tension, reflected by the PvO2, or mixed venous partial pressure of oxygen (normally 6 kPa, 45mmHg). Patients with a low PvO2 can be classed as stable or unstable depending on haemodynamics, ventilation, acid base status and urine output. If they are stable, no therapy is indicated until a true critical level is reached (PvO2 around 3 kPa, 23mmHg). If unstable, treatment must be intituted.

    Thus transfusion should be guided by haemodynamic stability, PvO2 and ER. Obviously during trauma resuscitation, haemodynamic stability is the key indicator.

    In summary :

    • If Hb > 10g/dl transfusion is rarely indicated.
    • If Hb < 7g/dl transfusion is usually necessary.
    • With Hbs between 7 and 10 g/dl, clinical status, PvO2 and ER are helpful in defining transfusion requirements.
• 

  skeeter1

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  skeeter1
• 

  skeeter1

  Why in the world is the Watchtower pointing brothers to an article about anemia? Anemia is a s-l-o-w loss of blood, not the real reason why JW women die with ob-blood issues. This BOE letter is trying to calm the brothers, hoodwinking them into thinking there is a solution for the JW women. There is, it's called "packed red blood cells" or "whole blood."

  Is the WTS trying to blame a woman's death on not getting pre-natal care or calling the HLC? What is the HLC going to recommend for hemorrhage blood loss?

  The REAL problem with blood loss and JW women is EXTREME HEMMORAGGING during vaginal childbirth, c-section, or hysterectomy.

  Why in the world is the Watchtower pointing brothers to an article about anemia? Anemia is a s-l-o-w loss of blood, not the real reason why JW women die with ob-blood issues.

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  Causes

  Causes of postpartum hemorrhage and their incidence

  Cause	Incidence
  Uterine atony	70%
  Trauma	20%
  Retained tissue	10%
  Coagulopathy	1%

  Causes of postpartum hemorrhage are uterine atony, trauma, retained placenta, and coagulopathy, commonly referred to as the "four Ts": [ 1 ]

  • Tone: uterine atony is the inability of the uterus to contract and may lead to continuous bleeding. Retained placental tissue and infection may contribute to uterine atony.
  • Trauma: trauma from the delivery may tear tissue and vessels leading to significant postpartum bleeding.
  • Tissue: retention of tissue from the placenta or fetus may lead to bleeding.
  • Thrombin: a bleeding disorder occurs when there a failure of clotting, such as with diseases known as coagulopathies.

  [edit] Management

  [edit] Medication

  Intravenous oxytocin is the drug of choice for postpartum hemorrhage. Misoprostol may also be effective is oxytocin is not available. [ 2 ]

  [edit] Protocol

  A detailed stepwise management protocol has been introduced by the California Maternity Quality Care Collaborative. [ 3 ] It describes 4 stages of obstetrical hemorrhage after a delivery and its application reduces maternal mortality. [ 4 ]

  • Stage 0: normal - treated with fundal massage and oxytocin.
  • Stage 1: more than normal bleeding - establish large-bore intravenous access, assemble personnel, increase oxytocin, consider use of methergine, perform fundal massage, prepare 2 units of packed red cells.
  • Stage 2: bleeding continues - check coagulation status, assemble response team, move to operating room, place intrauterine balloon, administer additional uterotonics (misoprostol, carboprost tromethamine), consider: uterine artery embolization, dilatation and curettage, and laparotomy with uterine compression stitches or hysterectomy.
  • Stage 3: bleeding continues - activate massive transfusion protocol, mobilize additional personnel, recheck laboratory tests, perform laparotomy, consider hysterectomy.

  A Cochrane database study [ 5 ] suggests that blood loss and the risk of postpartum bleeding will be reduced in women offered active management of the third stage of labour, rather than expectant management. However, the use of ergometrine for active management was associated with nausea or vomiting and hypertension, and controlled cord traction requires the immediate clamping of the umbilical cord.
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  skeeter1
• 

  skeeter1

  Obstetric Care of Jehovah's Witnesses: A 14-Year Observational Study

  Massiah, Nadine; Athimulam, Shobana; Loo, Chin; Okoto, Stanley; Yoong, Wai

  Abstract

  Numerous studies have looked at the outcome of various types of surgery in Jehovah's witnesses (JWs), who refuse blood and blood components, but comparatively little is known about obstetrical outcomes. The investigators reviewed 90 consecutive women who were JWs and who, over a 14-year period, had a total of 116 deliveries at an inner city hospital. They represented 0.2% of all deliveries in the unit during this period. Between 1992 and 2005, the number of JW deliveries increased more than 4-fold. Two-thirds of women had normal vaginal deliveries, while 24% had cesarean deliveries (14 elective and 14 emergent) and 10% had instrumental deliveries. In all instances the patient's status was known well before delivery, the potential risks were discussed, and a management plan formulated. All women received oral hematinics antenatally.

  In 21 of 116 deliveries the predelivery hemoglobin was less than 11 g/dL. One in 5 women lost more than 500 mL of blood at delivery, and 7 women (6%) lost more than a liter; none of them received transfusions. Following 38 deliveries, the hemoglobin was less than 11 g/dL, but the overall group mean value of 11.1 g/dL did not differ significantly from the mean predelivery hemoglobin of 11.8 g/dL. The rate of admission to intensive care was 2.5%. The single maternal death followed cesarean hysterectomy; it represented a 65-fold increase in the risk of maternal death compared to the national rate. There were 3 premature births before 34 weeks' gestation and a single term stillbirth, but no neonatal deaths.
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  skeeter1

  Epidemiology Maternal mortality and serious maternal morbidity in Jehovah's witnesses in the Netherlands ME Van Wolfswinkel a , JJ Zwart a , JM Schutte b , JJ Duvekot c , M Pel d , J Van Roosmalen a,e a Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands b Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, the Netherlands c Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynecology, Erasmus Medical Centre-University Medical Center Rotterdam, Rotterdam, the Netherlands d Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, the Netherlands e Section Health care and culture, VU Medical Center, Amsterdam, the Netherlands Correspondence to Dr JJ Zwart, Department of Obstetrics, K6-P-35, Leiden University Medical Centre, P.O. box 9600 Leiden, the Netherlands. Email: [email protected] Copyright © 2009 The authors Journal compilation © RCOG 2009 BJOG An International Journal of Obstetrics and Gynaecology KEYWORDS Jehovah's witnesses • maternal morbidity • maternal mortality • obstetric haemorrhage

  ABSTRACT

  Objective To determine the risk of maternal mortality and serious maternal morbidity because of major obstetric haemorrhage in Jehovah's witnesses in the Netherlands.

  Design A retrospective study of case notes.

  Setting All tertiary care centres, general teaching hospitals and other general hospitals in the Netherlands.

  Sample All cases of maternal mortality in the Netherlands between 1983 and 2006 and all cases of serious maternal morbidity in the Netherlands between 2004 and 2006.

  Methods Study of case notes using two different nationwide enquiries over two different time periods.

  Main outcome measures Maternal mortality ratio (MMR) and risk of serious maternal mortality.

  Results The MMR for Jehovah's witnesses was 68 per 100 000 live births. We found a risk of 14 per 1000 for Jehovah's witnesses to experience serious maternal morbidity because of obstetric haemorrhage while the risk for the total pregnant population was 4.5 per 1000.

  Conclusions Women who are Jehovah's witnesses are at a six times increased risk for maternal death, at a 130 times increased risk for maternal death because of major obstetric haemorrhage and at a 3.1 times increased risk for serious maternal morbidity because of obstetric haemorrhage, compared to the general Dutch population.
• 

  nelly136

  i'm surprised they didnt bring up the ivf and multiple spawnings by unatural means, there was a spate a whiles back of multiple births causing problems and blood issues arising leading to babies dying and blood transfusion court orders.
• 

  Farkel

  :Thank you very much for your loving efforts to provide protection and care to those who are close to welcoming a new member to their family.

  This is from the folks who wisely brought you the Radio Biola fraud, forbade vaccinations as "filthy animal pus", who told you it was better to slit your throat than to have a vaccination, who taught that organ transplants were cannibalism, who said that a person who was transfused with blood from a criminal would take on the personality of the criminal, who said the AMA was Babylonish Paganism, who said the heart was the body's main organ of emotion, who said that sleeping with your head pointed North was best for your health, and through all of that and most importantly, said they alone speak for God.

  Yeah. I believe that. Sure I do.

  Farkel
• 

  agonus

  "a person who was transfused with blood from a criminal would take on the personality of the criminal"

  I've said it before, I'll say it again: I honestly believe that the REAL reason for the blood ban is something along the lines of the above. They don't want to corrupt the precious blood of a believer with that of a filthy heathen unbeliever.