Management of women who decline blood and blood products in pregnancy

• Women decline blood products in pregnancy for religious reasons or because of concerns regarding their safety. • Mortality is significantly increased in pregnant women who decline blood products. • Antenatal counselling and planning must involve a senior multidisciplinary team. • Considerable efforts are needed to optimise pre-delivery haemoglobin and identify risk factors for haemorrhage. • Intrapartum techniques to avoid blood transfusion include cell salvage and early recourse to definitive surgical management in the event of massive obstetric haemorrhage. Learning objectives: • To understand the reasons why women decline blood and blood products in pregnancy and how this impacts on their health. • To understand the law relating to women who decline treatment in pregnancy. • To learn how to make the most of antenatal care opportunities. • To be able to plan labour and postpartum care. • To review the differences in managing massive obstetric haemorrhage between women who decline blood products and those who do not. Ethical issues: • Women's autonomy can be supported with accurate information and empathic counselling. • Given real concerns regarding the safety and availability of donor blood transfusion, should blood conservation techniques in obstetrics be applied to all women? Please cite this article as: Currie J, Hogg M, Patel N, Madgwick K, Yoong W. Management of women who decline blood and blood products in pregnancy. The Obstetrician & Gynaecologist 2010;12:13–20.