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

Abstract

Obstetric haemorrhage is one of the leading causes of maternal mortality. In many low-resource settings, delays in transport to referral facilities and in obtaining lifesaving treatment, contribute to maternal deaths. The non-pneumatic anti-shock garment (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. With brief training, even individuals without medical backgrounds can apply this first-aid device. In this secondary analysis of hospital data from a pre-post intervention study in Egypt (N=364 women with obstetric haemorrhage and shock), 158 received standard care, while 206 received standard care plus the NASG. The NASG significantly reduced blood loss, time to recovery from shock, and, for those with postpartum haemorrhage due to uterine atony who received oxytocin, the NASG had a significant effect on blood loss independent of oxytocin. These results indicate that the NASG may be a valuable innovation for reducing maternal mortality in low-resource settings. Testing at community and household levels will be necessary in order to determine whether the NASG can help women survive the longest delays.

Keywords:

• Maternal mortality
• safe motherhood
• obstetric haemorrhage
• maternal morbidity

Research for this paper was undertaken with support from the MacArthur Foundation and USAID Egypt. We thank Helen Cheng and Steve Shibosky of UCSF, WGHI for statistical consultation. Further, Amr Fathy, Ihab Nasshar, I Elshair, and the staff of El Galaa Teaching Hospital, Assiut University Teaching Hospital, El Minya University Teaching Hospital and Alexandria University Teaching Hospital are gratefully acknowledged. Dr. Turan's work on this article was also supported, in part, by grant # T32 MH-19105-17 from the National Institute of Mental Health (NIMH).

Notes

1. Alexandria University Teaching Hospital, Alexandria, Egypt; Al Minya University Teaching Hospital, Al Minya, Egypt; Assiut University Teaching Hospital, Assiut, Egypt; and El Galaa Teaching Hospital, Cairo, Egypt.

2. According to Creasy and Resnik (1994) Maternal and Fetal Medicine, moderate shock is indicated when the pulse is between 100–120 BPM, and severe shock when the pulse is above 120 BPM.

3. Early recognition of complication, first-aid emergency response, transport, and referral system.