Canterbury DHB

Antenatal care

Early referral to the Obstetric and Anaesthetic departments is essential so that adequate planning can occur. Involvement of the Hospital Liaison Committee for Jehovah’s Witnesses (Mark Proctor 027 435 3237 (mob), 03 376 4636 (res) and e-mail: metro1@xtra.co.nz) is helpful if the patient gives consent. A frank discussion should take place with the consultant obstetrician/anaesthetist detailing the risks of declining blood products including the risk of hysterectomy if massive haemorrhage occurs. All discussions should be documented. Again, the different blood products and interventions should all be discussed, including the use of anti-D immunoglobulin (which is derived from human plasma) and the woman’s stance on neonatal transfusion.

The 3 pillars of bloodless surgery should be employed (see adult elective surgery). Blood tests and ultrasound scans should proceed as they would normally with specific attention to maximising iron stores and identifying the placental site. A complete blood count, serum ferritin and group and screen should be performed at booking. A coagulation screen should also be checked if there is a personal or family history of bleeding [19]. Oral iron supplements should be recommended as first line prophylaxis. Intravenous iron should be considered if time is limited or oral iron is not acceptable – see the CDHB Antenatal Intravenous Iron Infusion Protocol.

Autologous blood deposition is not recommended in pregnancy as concerns exist about antenatal anaemia and placental insufficiency [19]. Recombinant human erythropoietin is not normally used in this setting but has been used in patients antenatally and postpartum without any adverse maternal, fetal or neonatal effects [19].

Topic Code: 47851