Can the Non-pneumatic Anti-Shock Garment (NASG) reduce adverse maternal outcomes from postpartum hemorrhage? Evidence from Egypt and Nigeria

Mohammed Mourad-Youssif, Oladosu A Ojengbede, Carinne D Meyer, Mohammad Fathalla, Imran O Morhason-Bello, Hadiza Galadanci, Carol Camlin, David Nsima, Tarek Al Hussaini, Elizabeth Butrick, Suellen Miller, Mohammed Mourad-Youssif, Oladosu A Ojengbede, Carinne D Meyer, Mohammad Fathalla, Imran O Morhason-Bello, Hadiza Galadanci, Carol Camlin, David Nsima, Tarek Al Hussaini, Elizabeth Butrick, Suellen Miller

Abstract

Background: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality and severe maternal morbidity. The Non-pneumatic Anti-Shock Garment (NASG), a first-aid lower-body compression device, may decrease adverse outcomes from obstetric hemorrhage. This article is the first to report the effect of the NASG for PPH.

Methods: This pre-intervention/NASG study of 854 women was conducted in four referral facilities in Nigeria and two in Egypt between 2004-2008. Entry criteria were 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. The Wilcoxon rank-sum test and relative risks with 95% confidence intervals were calculated for primary outcomes - measured blood loss, emergency hysterectomy, mortality, morbidity (each individually), and a combined variable, "adverse outcomes", defined as severe morbidity and mortality. A multiple logistic regression model was fitted to test the independent association between the NASG and the combined severe morbidity and mortality outcome.

Results: Measured blood loss decreased by 50% between phases; women experienced 400 mL of median blood loss after study entry in the pre-intervention and 200 mL in the NASG phase (p < 0.0001). As individual outcomes, mortality decreased from 9% pre-intervention to 3.1% in the NASG phase (RR 0.35, 95% CI 0.19-0.62); severe morbidity decreased from 4.2% to 1%, in the NASG phase (RR 0.24, 95% CI 0.09-0.67). As a combination, "adverse outcomes," decreased from 12.8% to 4.1% in the NASG phase (RR 0.32, 95% CI 0.19-0.53). In a multiple logistic regression model, the NASG was associated with the combined outcome of severe maternal morbidity and mortality (OR 0.42, 95% CI 0.18-0.99).

Conclusion: In this non-randomized study, in which bias is inherent, the NASG showed promise for reducing blood loss, emergency hysterectomy, morbidity and mortality associated with PPH in referral facilities in Egypt and Nigeria.

Figures

Figure 1
Figure 1
An NASG fully applied.

References

    1. Knight M, Callaghan WM, Berg C, Alexander S, Bouvier-Colle M, Ford JB, Joseph KS, Lewis G, Liston RM, Roberts CL, Oats J, Walker J. Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group. BMC Pregnancy and Childbirth. 2009;9 doi: 10.1186/1471-2393-9-55.
    1. WHO. Integrated Management of Pregnancy and Childbirth (IMPAC) Geneva: WHO, Department of Reproductive Health and Research; 2000. Managing Complications in Pregnancy and Childbirth: A guide for midwives and doctors.
    1. McCarthy J, Maine D. A framework for analyzing the determinants of maternal mortality. Stud Fam Plann. 1992;23:23–33. doi: 10.2307/1966825.
    1. ICM/FIGO. Joint Statement: Prevention and Treatment of Post-partum Haemorrhage. New Advances for Low Resource Settings. 2006.
    1. Lalonde A, Daviss BA, Acosta A, Herschderfer K. Postpartum hemorrhage today: ICM/FIGO initiative 2004-2006. Int J Gynaecol Obstet. 2006;94:243–253. doi: 10.1016/j.ijgo.2006.04.016.
    1. Miller S, Martin HB, Morris JL. Anti-shock garment in postpartum haemorrhage. Best Pract Res Clin Obstet Gynaecol. 2008;22:1057–1074. doi: 10.1016/j.bpobgyn.2008.08.008.
    1. Brees C, Hensleigh PA, Miller S, Pelligra R. A non-inflatable anti-shock garment for obstetric hemorrhage. Int J Gynaecol Obstet. 2004;87:119–124. doi: 10.1016/j.ijgo.2004.07.014.
    1. Hensleigh PA. Anti-shock garment provides resuscitation and haemostasis for obstetric haemorrhage. BJOG. 2002;109:1377–1384. doi: 10.1046/j.1471-0528.2002.02197.x.
    1. Miller S, Hamza S, Bray E, Gipson R, Nada K, Fathalla MF, Mourad M. First Aid for Obstetrical Haemorrhage: The Pilot Study of the Non-pneumatic Anti-Shock Garment (NASG) in Egypt. BJOG. 2006;113:424–429. doi: 10.1111/j.1471-0528.2006.00873.x.
    1. Miller S, Turan J, Dau K, Fathalla M, Mourad M, Sutherland T, Hamza S, Lester F, Gibson E, Gipson R. et al.Use of the non-pneumatic anti-shock garment (NASG) to reduce blood loss and time to recovery from shock for women with obstetric haemorrhage in Egypt. Global Public Health. 2007;2:110–124. doi: 10.1080/17441690601012536.
    1. Miller S, Ojengbede O, Turan JM, Morhason-Bello IO, Martin HB, Nsima D. A comparative study of the non-pneumatic anti-shock garment for the treatment of obstetric hemorrhage in Nigeria. Int J Gynaecol Obstet. 2009;107:121–125. doi: 10.1016/j.ijgo.2009.06.005.
    1. Miller S, Fathalla MM, Youssif MM, Turan J, Camlin C, Al-Hussaini TK, Butrick E, Meyer C. A comparative study of the non-pneumatic anti-shock garment for the treatment of obstetric hemorrhage in Egypt. Int J Gynaecol Obstet. 2010;109:20–24. doi: 10.1016/j.ijgo.2009.11.016.
    1. Kodkany B, Derman R. In: A Textbook of Postpartum Hemorrhage. B-Lynch C, Keith L, Lalonde A, Karoshi M, editor. 2006. Pitfalls in Assessing Blood Loss and Decision to Transfer.
    1. The Clinician's Ultimate Reference - Mean Arterial Pressure.
    1. Mantel G, Buchmann E, Rees H, Pattinson RC. Severe acute maternal morbidity: a pilot study of a definition for a near-miss. BJOG. 1998;105:985–990. doi: 10.1111/j.1471-0528.1998.tb10262.x.
    1. Hofmeyr GJ, Gulmezoglu AM, Novikova N, Linder V, Ferreira S, Piaggio G. Misoprostol to prevent and treat postpartum haemorrhage: a systematic review and meta-analysis of maternal deaths and dose-related effects. Bull World Health Organ. 2009;87:666–677. doi: 10.2471/BLT.08.055715.
    1. WHO. WHO guidelines for the management of postpartum haemorrhage and retained placenta. Geneva: World Health Organization; 2009. p. 48. pp. 48.
    1. Akhter S, Begum MR, Kabir J. Condom hydrostatic tamponade for massive postpartum hemorrhage. Int J Gynaecol Obstet. 2005;90:134–135. doi: 10.1016/j.ijgo.2005.03.018.
    1. Danso D, Reginald PW. In: Postpartum Hemorrhage: New Thoughts, New Approaches (International Federation of Obstetrics and Gynecology) C B-lynch AL, West L, editor. London: Sapiens Publications; 2006. Internal Uterine Tamponade.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera