Secondary abdominal pregnancy in a Jehovah's Witness

A 35-year-old woman, gravida 2, para 1, aborta 0, arrived at our emergency department with abdominal pain of more than 2 weeks' duration. Diagnostic p elvic ultrasonography confirmed a 16-week intra-abdominal pregnancy. Hemogl obin level was 6.9 mg/dL, and hematocrit value was 20.1%. The patient refus ed blood transfusion on religions grounds. Laparotomy revealed 2,000 mt of blood in the abdomen and a live fetus, with the placenta attached to the om entum and the serosal surface of the right fallopian tube. Postoperative he moglobin level was 2.8 mg/dL, The patient was transferred to another facili ty for hyperbaric oxygen therapy, where she subsequently died, Abdominal pr egnancy is rare, but has high fetal and maternal mortality rates. Our patie nt's case was complicated, since she was a Jehovah's Witness and refused li fesaving treatment on religious grounds. Serious medical decisions were mad e, while respecting the autonomy of the patient.