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 in-hospital.

Methods: Pre/post studies of the NASG were conducted at hospitals in Cairo (n = 349 women), Assuit (n = 274), Southern Nigeria (n = 57), and Northern Nigeria (n = 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 (χ(2) = 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.

Figures

FIG. 1.

The non-pneumatic anti-shock garment (NASG) being applied.

FIG. 2.

Time intervals in accessing care experienced by women with hemorrhage and hypovolemic shock. IV, intravenous.