• Burak Zeybek, Andrew M Childress, Gokhan S Kilic, John Y Phelps, Luis D Pacheco, Michele A Carter, and Mostafa A Borahay.
• Resident Physician, Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, TX.
• Obstet Gynecol Surv. 2016 Aug 1; 71 (8): 488-500.

ImportanceObstetricians and gynecologists frequently deal with hemorrhage so they should be familiar with management of patients who refuse blood transfusion. Although there are some reports in the literature about management of Jehovah's Witness patients in obstetrics and gynecology, most of them are case reports, and a comprehensive review about these patients including ethicolegal perspective is lacking.ObjectiveThis review outlines the medical, ethical, and legal implications of management of Jehovah's Witness patients in obstetrical and gynecological settings.Evidence AcquisitionA search of published literature using PubMed, Ovid Medline, EMBASE, and Cochrane databases was conducted about physiology of oxygen delivery and response to tissue hypoxia, mortality rates at certain hemoglobin levels, medical management options for anemic patients who refuse blood transfusion, and ethical/legal considerations in Jehovah's Witness patients.ResultsEarly diagnosis of anemia and immediate initiation of therapy are essential in patients who refuse blood transfusion. Medical management options include iron supplementation and erythropoietin. There are also some promising therapies that are in development such as antihepcidin antibodies and hemoglobin-based oxygen carriers. Options to decrease blood loss include antifibrinolytics, desmopressin, recombinant factor VII, and factor concentrates. When surgery is the only option, every effort should be made to pursue minimally invasive approaches.Conclusion And RelevanceAll obstetricians and gynecologists should be familiar with alternatives and "less invasive" options for patients who refuse blood transfusions.

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