First aid for obstetric haemorrhage: the pilot study of the non‐pneumatic anti‐shock garment in Egypt

Abstract

Objective To compare the effect of non-pneumatic anti-shock garment (NASG) on blood loss from obstetric haemorrhage with standard management of obstetric haemorrhage.Design Observational study of consecutive obstetric haemorrhage cases before and after introduction of the NASG.Setting Four tertiary care maternity facilities in Egypt.Sample The sample consisted of women with obstetric haemorrhage and signs of shock and the entry criteria were: >750 mL of blood loss and either pulse of >100 beats per minute or systolic blood pressure of <100 mmHg. A total of 158 women were in the preintervention group and 206 in the postintervention group.Methods All the women with haemorrhage meeting the eligibility criteria were treated according to the standard protocol for 4 months (May-August 2004); blood loss was measured and recorded. The NASG was then introduced, and all the women meeting the eligibility criteria were treated according to the standard haemorrhage protocol plus the NASG for 4 months (September-December 2004).Main outcome measures Measured blood loss collected in a closed-end, graduated, plastic, under buttocks collection drape.Results Median measured blood loss in the drape following study entry was 50% lower in those treated with the NASG (250 versus 500 mL, P < 0.001). There was also a non-statistically significant decrease in morbidity and mortality.Conclusions This is the first comparative study of the NASG with a standard obstetric haemorrhage treatment protocol. The NASG shows promise for management of obstetric haemorrhage, particularly in lower resource settings. Larger studies will be needed to determine if the NASG contributes to statistically significant decreases in morbidity and mortality.

Effectiveness of Non-pneumatic Anti-shock Garment (NASG) in Preventing Shock-related Morbidity and Mortality in Severe Hemorrhagic Shock

“…Ensure patient's airway is patent and give oxygen. Several studies including this work have confirmed the effectiveness of the NASG as a first-aid-lifesustaining-device that can sustain the lives of critical ill shock patients until cross matched blood and definitive interventions become available [12][13][14][15][16][17]. The normal saline infusion was limited to 1.5 liter instead of the usual recommendation of 3:1 to avoid fluid overload as the vascular volume is restricted by the NASG application.…”

“…It is a lower body suit of articulated neoprene and Velcro segments that provides rapidly lower body circumferential counter pressure of 20-40 mmHg that decreases the distal aortic mean baseline blood flow of 1.99 l/min by 0.65, and thus shunts blood flow from the lower limbs and the pelvis to the heart, brain, lungs and kidneys like during the compensatory stage of hypovolemic shock [13,14]. Studies in Egypt and Nigeria on obstetric hemorrhage confirmed that the NASG can reduce pelvic blood loss by 50%, prevent emergency hysterectomy, and shock-related morbidities like irreversible shock, multiple organ failures and maternal deaths [15][16][17]. The aims of this study are to reappraisal the effectiveness of NASG in averting maternal deaths and shock-related morbidities in severe obstetric hemorrhagic shock patients, and to make recommendations.…”

Positive Effects of the Non-pneumatic Anti-shock Garment on Delays in Accessing Care for Postpartum and Postabortion Hemorrhage in Egypt and Nigeria

“…14,15 Larger pre-post studies in Egypt and Nigeria indicate that NASG use can significantly reduce maternal mortality and extreme adverse outcomes (EAO) (maternal death or severe maternal morbidity). In Nigeria, the relative risk (RR) of mortality in the NASG intervention phase, compared to the pre-intervention phase was 0.32 (95% confidence interval [CI] 0.14-0.72), 16 and in Egypt, the RR of EAO with the NASG was 0.36 (95% CI 0.16-0.80).…”

Nyttig bidrag for å redusere mødredødelighet

“…Case studies and case series have, however, been published and summarized (81)(82)(83)(84)(85)(86)(87). The use of nonpneumatic antishock garments (NASGs) has been reported in a before-and-after study of 634 women with obstetric haemorrhage (43% with uterine atony) in Egypt (88).…”