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Complications of Ectopic Pregnancy

An ectopic pregnancy is a pregnancy complication when the attachment of the fertilized egg occurs outside the uterine cavity. With a few exceptions, the fetus is not viable in the case of ectopic pregnancy. Besides, it is often dangerous for the health of the mother due to possible internal bleeding. Ectopic pregnancy refers to a condition requiring emergency care because without treatment it can be fatal. The death rate from ectopic pregnancy in the structure of maternal mortality ranked first place for the last five years in the civilized countries of the world (Leveno et al., 2012, p. 13). Its main causes are a delay in diagnosis of the disease and inadequate replenishment of blood loss. Moreover, a serious obstacle for proper treatment can be religious beliefs of some patients which refuse certain medical practices. Some religions are so strict that a patient prefers to die rather than contradict its norms and rules.  Jehovah’s Witnesses Organization is one of the religions which obey severe rules and bans regarding medical treatment.  Thus, providing medical care in case of ectopic pregnancy can be complicated due to several reasons. This paper will examine the most probable concerns of the woman belonging to Jehovah’s Witnesses Organization, who is suffering from ectopic pregnancy. The paper will also discuss the most appropriate response of the medical team regarding these concerns. Furthermore, it will reveal the possible compromises between traditional medicine and religious beliefs, which are extremely important for saving the life of the patient with ectopic pregnancy.

Jehovah’s Witnesses is a religion which involves certain severe rules regarding the whole life of its adepts and the health field in particular. Doctrine allows birth control only through the use of contraceptives. In agreement with biblical principles, Jehovah’s Witnesses never resort to abortion since it is contrary to God’s Word. Often the woman is consciously willing to die rather than break God’s commandment “Thou shalt not kill” and undergo an abortion (McCarty, 2014, p. 34). Jehovah’s Witnesses not only encourages celibacy but also advises couples not to have children. According to McCarty (2014), the organization acknowledges that childbearing is a part of God’s commandments, however, at the same time they state:

Today, childbirth is not an indispensable part of the job Jehovah gave his people. The decision whether to have children or not is a personal matter of the couple, which they have to make themselves. However, since “time is short”, it would be nice if the couple carefully weighed the pros and cons of the childbirth at the present time.

Thus, many couples postpone the birth and upbringing of children until the new world comes.

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Ectopic pregnancy can lead to the death with a very high percentage of probability. Jehovah’s Witnesses believe that after the physical death a believer remains in a tomb devoid of the conscious existence until he or she is resurrected by God. Jehovah’s Witnesses do not believe that the human soul is an independent creature endowed with consciousness. At the Second Coming of Christ, the body of the deceased believers will rise from their graves and be reunited with their souls and spirits. Righteous people will be resurrected to “the renewed Earth,” where they will be immortal and will not know the diseases and grief (McCarty, 2014, p. 20). The fate of the unrighteous people and sinners is not directly illuminated; apparently, they just will not be resurrected. According to these beliefs, one can suggest that the women suffering from ectopic pregnancy will refuse any medical treatment which is considered unacceptable in terms of doctrine. They will better die in order to gain eternal life at the Second Coming of Christ then accept the medical intervention and save their own life but become a sinner in the eyes of God and lose the chance for salvation.

Jehovah’s Witnesses believe that Jehovah can sustain his believers “on a bed of sickness” (Rhodes, 2009, p. 56). Although nowadays Jehovah does not save from diseases by miracle, he does not leave his children without help. The principles recorded in his Word help Jehovah’s Witnesses to make decisions about treatment. In addition, believers can find practical information articles that discuss certain diseases in the “Watchtower” and “Awake!”. Jehovah’s Witnesses believe that Jehovah can strengthen them through his spirit, and give “the power beyond what is normal” to help cope with the disease and, in spite of disease, to keep faithful to him (Rhodes, 2009, p. 57). These beliefs require Jehovah’s Witnesses not to be obsessed with their illness because spirit should occupy the most important place in people’s lives. Being uninformed about the danger of ectopic pregnancy, the couple might rely on Jehovah and wait for his help. That is the reason why medical team should provide an in-depth explanation of the patient’s state and the risks of it to convince the patient to accept proper medical treatment.

It would be a mistake to state that Jehovah’s Witnesses refuse medical treatment. If necessary, they seek medical help, and many of them work in hospitals. They accept the majority of diagnostic and therapeutic procedures available today. As all people, Jehovah’s Witnesses want to live as long as possible and stay healthy. Jehovah’s Witnesses do not recognize faith healing. Every Jehovah’s Witness chooses the method of treatment at their own discretion.

However, Jehovah’s Witnesses are known throughout the world for refusal to accept blood transfusions even under the threat of death in case of failure of this procedure (Shaner & Prema, 2014). According to the teachings of Jehovah’s Witnesses, the Bible clearly affirms that blood is sacred in the eyes of God, since the blood is the soul of humans or other living creature. For this reason, they should not use blood as food, including eating animal meat from which the blood has not been drained properly. For the same reason, Jehovah witnesses refuse any other form of acceptance of blood or any of its four main components – erythrocytes, leukocytes, platelets, and/or plasma (however, it does not relate to the artificial blood substitute) (Wong, 2012). At the same time, every Jehovah’s Witness composes their own opinion and acts as conscience dictates on reception of small blood fractions (such as albumin, immune globulin, hemoglobin, etc) (Leveno et al., 2012, p. 96). This ban is considered the fulfillment of the rule about abstaining from blood. Furthermore, each member of the Organization is strongly recommended to carry a written refusal of the blood transfusion, issued on a special form. It can cause a serious problem during dealing with ectopic pregnancy since this compliance can require the immediate operation with applying of blood transfusion. Thus, the women from Jehovah’s Witnesses will accept the administration of pain medication and antibiotics but will certainly refuse blood transfusion even in case of the death threat (Rhodes, 2009, p. 102).

The main purpose of the medical team when dealing with the patient with ectopic pregnancy from Jehovah’s Witnesses Organization is to give a proper explanation of her state and risks it causes. If such an error in reproductive physiology occurs, the egg implants in the fallopian tubes, rarely in the ovary, and sometimes in the abdominal cavity. Implantation of the embryo outside the uterine cavity, where there is no sufficient space for its growth and development, is dangerous for the health of the mother. In ectopic pregnancy growth of the embryo can lead to rupture of the organ in which it is implanted and cause heavy bleeding (Leveno et al., 2012, p. 90). This endangers the life of the pregnant woman. The fetus grows, causing sharp stabbing pain in abdomen or pelvis; eventually, it will break the organ which contains it. Only immediate surgery can help in this case. Untimely and improper provision of surgical care can cause a deadly threat to the woman. Thus, the medical team has very short time for dealing with such a situation. It would not be a mistake to suggest executing an operation in next one or two hours.

It is important to explain that in case of ectopic pregnancy, the abortion cannot be considered murder, since it ultimately ends by the death of fetus. With this type of pregnancy, the fetus cannot survive because the normal development of the fetus and the placenta can occur only in the uterus. Moreover, malformations of the fetus and its coalescence with the surrounding body organs are frequently observed (Leveno et al., 2012, p. 88). The chances of having a living and a healthy child survived are very low, while the danger for a woman’s life is great. The surgery should be maintained promptly, as soon as the diagnosis has been made. Thus, there is no need for woman to sacrifice herself since the fetus is initially not viable.

The necessary medical model for this patient’s situation is as follows: in case of ectopic pregnancy, two kinds of surgery can be applied in medical practice. One is laparotomy or abdominal surgery, and another is microsurgical procedure – laparoscopy (Church, 2014, p. 67). In most cases, laparoscopic surgery, which removes only the ovum or the fallopian tube during its break, is maintained. During laparoscopy, three small punctures are made in the abdomen under general anesthesia. Carbon dioxide is injected into the peritoneum, while the tools – trocars, through which the image of the pelvic organs is transmitted to the monitor, are introduced inside. However, features of laparoscopy (optical zoom, miniature tools) in many cases allow saving the fallopian tube. The surgeon’s choice depends on the location of the ovum, the state of the fallopian tube, and its size. The surgeon decides whether to keep the tube or remove it. Postponement of operation is unacceptable since this may lead to breakthrough bleeding and death (Church, 2014, p. 69).

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Since Jehovah’s Witnesses require the use of alternative therapies that do not include a blood transfusion, the physician can use autotransfusion if possible. It is transfusion of their own blood to the patients. Indications for autotransfusion include presence of a rare blood group of the patient and impossibility of matching donors. However, in case of emergency patient’s religious beliefs can serve as a reason for applying autotransfusion. Reinfusion of blood is a kind of autotransfusion which is often used in cases of ectopic pregnancy. It involves transfusion to the patient his their own blood, streamed into the surgical wound or serous cavities (abdominal, chest) which has been held there for no more than 12 hours (with a longer term the risk of infection increases) (Church, 2014, p. 78).

The outcome of the failure to deliver care for the patient can result in the woman’s death due to the rupture of organ containing developing cells. Women’s or her family members’ refusal to maintain an operation will result in the same outcome.  Refusal to apply blood transfusions might lead to the death from an effusion of blood. Thus, only following the doctor’s instructions can save the woman’s life in this situation. For the medical team failure to deliver culturally sensitive care for the patient with absolute probability will result in loss of the patient and probably in a claim against the physician or the entire hospital.

Sometimes religious beliefs of the patients can significantly complicate medical treatment. Jehovah’s Witnesses refuse blood transfusions and abortions. It is especially dangerous for the women suffering from ectopic pregnancy, since it often can lead to the death. It is extremely important for medical team to ensure that patient is aware of these compliances and realizes the potential risks. When health emergencies and religious beliefs confront, some severe rules can lead to the death of the patient. In case of ectopic pregnancy, it is important to understand that the fetus is not vial initially, therefore, abortion cannot be considered as a murder and a sin. In order to meet patient’s religious beliefs and avoid blood transfusions of another person, medical team also can perform autotransfusion. Thus, when conducting a constructive conversation, it is possible to convince patient about necessity of appropriate medical treatment. It is extremely important since reaching a compromise allows medical team to save patient’s life and avoid probable negative consequences.