Assessing the Role of the Non-Pneumatic Anti-Shock Garment in Reducing Mortality from Postpartum Hemorrhage in Nigeria

Abstract

Background/Aims: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality. The non-pneumatic anti-shock garment (NASG), a first-aid lower-body pressure device, may decrease mortality. Methods: This pre-intervention/NASG study of 288 women was conducted in four referral facilities in Nigeria, 2004–2008. Entry criteria: women with PPH due to uterine atony, retained placenta, ruptured uterus, vaginal or cervical lacerations or placenta accreta with estimated blood loss of ≧750 ml and one clinical sign of shock. Differences in demographics, conditions on study entry, treatment and outcomes were examined. t tests and relative risks with 95% confidence intervals were calculated for primary outcomes – measured blood loss and mortality. Multiple logistic regression analysis was performed to examine independent association of the NASG with mortality. Results: Mean measured blood loss decreased by 80% between phases. Women experienced 350 ml of median blood loss after study entry in the pre-intervention and 50 ml in the NASG phase (p < 0.0001). Mortality decreased from 18% pre-intervention to 6% in the NASG phase (RR = 0.31, 95% CI 0.15–0.64, p = 0.0007). In a multiple logistic regression model, the NASG was associated with reduced mortality (odds ratio 0.30; 95% CI 0.13–0.68, p = 0.004). Conclusion: The NASG shows promise for reducing mortality from PPH in referral facilities in Nigeria.

Midwives' knowledge and utilization of non-pneumatic anti shock garment in reducing complication of postpartum haemorrhage in selected health care facilities in Bayelsa state Nigeria

“…3,4 Meyer et al stated that 30% of maternal deaths in Africa are due to postpartum hemorrhage. 5 This is to say that postpartum hemorrhage is a major threat to maternal health and a myth to achievement of millennium development goal 5 of improving maternal health. 6 Nevertheless, these are unnecessary deaths that can be prevented and one way of preventing these deaths is by the use of the Non-pneumatic anti shock garment (NASG) which is low technology first aid device that can be placed around the lower body of a woman who has gone in to shock from obstetric bleeding.…”

“…8 When delays in the management of PPH occur, first aid is needed to resuscitate and stabilize women with PPH until definitive treatment is obtained. The NASG made from neoprene and velcro each of its six segments is sequentially wrapped tightly around a hemorrhaging woman's legs, pelvis and abdomen.…”

“…Furthermore, women in the NASG phase experienced better outcomes. 8 According to Onasoga et al, Midwives are the first point of contact for most women during pregnancy and labour and all women are at risk of PPH, therefore midwives' knowledge and utilization of the NASG which is a quick and adequate way of providing emergency obstetric care during PPH especially in limited resource area where there is accessibility problems during transport or referral as well as delays in receiving care. 11 Hence, the overall objective of this study was to assess midwives' knowledge and utilization of the NASG in the management of postpartum hemorrhage.…”

Reflexed Compression Suture for the Management of Atonic Postpartum Hemorrhage with an Abnormally Adherent Placenta

“…Postpartum hemorrhage (PPH) is one of the major obstetric emergencies and the leading contributor to maternal mortality and morbidity globally, accounting for 30% or more of all maternal deaths [1,2,3]. It is estimated that worldwide at least 127,000 women per annum bleed to death during or immediately after labor, but 90% of maternal deaths due to PPH are in fact preventable [1,2,3,4].…”

Postpartum Uterine Bleeding from the Inferior Mesenteric Artery: Case Report and Review of the Literature

“…The World Health Organization (WHO) estimates that approximately 150,000 women die each year from PPH owing to excessive bleeding [3,4]. The definitions of PPH vary, but PPH is most often defined as bleeding of more than 500 ml from the female genital tract within 24 h after vaginal delivery or of more than 1,000 ml after cesarean section [5,6,7].…”