Management of Placenta Previa in a Jehovah's Witness Patient

Placenta previa is the partial or complete covering of the internal os of cervix. It is one of the major risk factors for postpartum hemorrhage (PPH), maternal and neonatal morbidity and mortality. A 36-year-old G3P2 Jehovah's Witness female with a gestational age of 36 weeks 6 days and past medical history of chronic hypertension, T2DM, asthma, and past obstetric history of two cesarean sections, large for gestational age babies, and postpartum hemorrhage due to uterine atony, underwent an elective repeat low transverse cesarean section in view of posterior complete placenta previa, complicated by massive postpartum hemorrhage. The patient was immediately transported to the interventional radiology (IR) for uterine artery embolization (UAE) after unsuccessful treatment attempts with uterotonics and JADA system (vacuum induced uterine tamponade). In view of rapidly progressing bleeding, the decision was made for an urgent hysterectomy. Management of postpartum hemorrhage in a Jehovah's Witness patient is particularly complex as these patients refuse administration of blood products and involves medical, ethical, and legal implications.