Management of women who decline blood and blood products in pregnancy


Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UK Email:


  • • 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.