ABSTRACT
Some women decline transfusion because of specific personal or religious beliefs. The main group of women who may refuse for religious reasons are members of the Jehovah's Witnesses. She should be asked if she is willing to receive blood transfusion in a life-threatening emergency, and her reply should be noted. It should be clear what interventions she will accept and which ones she does not want: If an ultrasound scan shows a low-lying placenta, then the implications should be discussed with the woman. In cases of severe bleeding, tranexamic acid and IV vitamin K should be given to the woman. If the woman survives the acute episode and is transferred to ITU, management there should include erythropoietin, parenteral iron therapy and adequate protein for haemoglobin synthesis. The timing of hysterectomy is an on-the-spot decision for the consultant. When hysterectomy is performed, the uterine arteries should be clamped as early as possible in the procedure.
