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

Abstract

Background: We examined whether the non-pneumatic anti-shock garment (NASG) ameliorates the effects of delays in transport to and treatment at hospitals for women with postpartum hemorrhage (PPH) and postabortion hemorrhage (PAH) and investigated the effects of NASG use on timing of delivery of interventions inhospital. Methods: Pre=post studies of the NASG were conducted at hospitals in Cairo (n ¼ 349 women), Assuit (n ¼ 274), Southern Nigeria (n ¼ 57), and Northern Nigeria (n ¼ 124). In post-hoc analyses, comparisons of delays were conducted using analysis of variance (ANOVA), and associations of delays with extreme adverse outcomes (EAO, mortality or severe morbidity) were examined using chi-square tests, odds ratios (ORs), and multivariate logistic regression. Results: Median minutes from hemorrhage start to study admission differed by site, ranging from 15 minutes in Cairo to 225 minutes in Northern Nigeria ( p < 0.001). Median minutes from study admission to blood transfusion ranged from 30 minutes in Cairo to 209 minutes in Southern Nigeria ( p < 0.001). Twenty percent of women with !60 minutes between hemorrhage start and study admission experienced an EAO without the NASG compared with only 6% with the NASG (w 2 ¼ 13.71, p < 0.001). In-hospital delays in receiving intravenous (IV) fluids and blood were more common in the NASG phase. Conclusions: Women with PPH or PAH in Egypt and Nigeria often face delays in reaching emergency obstetrical care facilities and delays in receiving definitive therapies after arrival. Our results indicate that the NASG can reduce the impact of these delays. Stabilization does not replace treatment, however, and delays in fluid=blood administration with NASG use must be avoided.

Prevention and treatment of postpartum hemorrhage in low-resource settings

“…It also compresses the diameter of pelvic blood vessels, thus decreasing blood flow [33]. In preliminary pre‐intervention/intervention trials in tertiary facilities in Egypt and Nigeria, the NASG was shown to significantly improve shock [34], decrease blood loss, reduce emergency hysterectomy for atony, and decrease maternal mortality and severe maternal morbidities associated with obstetric hemorrhage [35,36]. A definitive trial of the NASG for use prior to transport from lower‐level facilities to tertiary facilities is currently underway in Zambia and Zimbabwe.…”

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

“…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. This garment decreases blood loss, recovers women from shock and keeps them alive while awaiting treatment According Miller et al, the NASG is a low-technology pressure device that decreases blood loss, restores vital signs, and has the potential to improve adverse outcomes by helping women survive delays in receiving adequate emergency obstetric care.…”

Use of non-pneumatic anti shock garment in hemorrhagic shock

“…[5][6][7][8][9] The non-pneumatic anti-shock garment (NASG) is a firstaid device that can save lives of women experiencing obstetric hemorrhage from any aetiology. 10 The use of the NASG reportedly addresses the immediate lifethreatening complication by reversing hypovolemic shock among mothers having shock due to PPH and returns blood to the heart, lungs, and brain by applying pressure to the lower body and abdomen. 11 The use of an NASG can stabilize a patient while awaiting transport, during transport, or during delays in receiving care at referral facilities.…”