Maternal Mortality and Serious Maternal Morbidity in Jehovah's Witnesses in The Netherlands EDITORIAL COMMENT

Refusal of blood by women with major obstetric hemorrhage who are Jehovah's witnesses increases their risk of maternal death. This retrospective study of case notes assessed the risk of maternal morbidity and mortality from major obstetric hemorrhage in Jehovah's witnesses. The data was obtained from all tertiary care centers and general hospitals in The Netherlands. The investigators examined case notes of Jehovah's witnesses who had serious maternal morbidity between 2004 and 2006. Mortality data for the years between 1983 and 2006 was also examined. The incidence of maternal morbidity and mortality in Jehovah's witnesses was compared with the total incidence of maternal morbidity reported in a previous study and the total incidence of maternal mortality reported to the Maternal Mortality Committee. The primary study outcome was the maternal mortality ratio (MMR) and risk of serious maternal mortality. A total of 8850 deliveries by Jehovah's witnesses was reported during the study years. Death occurred in 6 of these mothers as a direct result of major obstetric hemorrhage. This represents a MMR of 68 per 100,000 live births, which is 6 times higher than in the general Dutch population and 130 times higher than the reported MMR from major obstetric hemorrhage. The risk of serious maternal morbidity because of obstetric hemorrhage among Jehovah's witnesses was 14 per 1000 births, whereas the risk in the total population of pregnant Dutch women was 4.5 per 1000. This represents a 3.1 times higher risk of serious maternal morbidity in Jehovah's witnesses compared with the general Dutch population. These findings demonstrate the consequences of the refusal of Dutch Jehovah's witnesses with major obstetric hemorrhage to accept transfusion of blood or major blood components. Because some Witnesses may accept treatment with blood products such as coagulation factors and erythropoietin, the investigators suggest that available alternatives to red blood cell transfusion should be discussed with these women early in pregnancy