EMERGENCY MANAGEMENT OF HEAVY UTERINE BLEEDING IN A JEHOVAS WITNESS

A 40 yr. old Jehovah's Witness presented with acute blood loss secondary to heavy uterine bleeding. At admission hemoglobin was 5.0 mg/dl. She was treated with IV estrogen and crystalloid solutions. With unsuccessful medical management, refusal of transfusion of blood and consultation with anesthesia team, the decision was made to do endometrial curettage and thermal ablation under conscious sedation. The patient bleeding was controlled and her post-operative hemoglobin was 4.8 mg/dl. She was treated with human erythropoietin, oral iron, folic acid and vitamin B12. Later she underwent exploratory laparotomy for evaluation of her large complex adnexal mass. At the laparotomy lysis of adhesions, total abdominal hysterectomy, bilateral salphingooophorectomy and umbilical hernia repair was performed. The pathology of the mass was identified as tubo-ovarian abscess. Although endometrial ablation is usually done to avoid major surgery, it can be lifesaving in cases of hemodynamically unstable patients and special circumstances such as Jehovah as witnesses. Endometrial ablation usually provides long term treatment, however its use as a short term solution can be lifesaving.