Research
Can the Non-pneumatic Anti-Shock Garment (NASG) reduce adverse maternal outcomes from postpartum hemorrhage? Evidence from Egypt and Nigeria
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* Corresponding author: Suellen Miller suellenmiller@gmail.com
1 Department of Obstetrics & Gynecology, El Galaa Maternity Teaching Hospital, Cairo, Egypt
2 Center for Population and Reproductive Health, College of Medicine/University College Hospital, University of Ibadan, Ibadan, Nigeria
3 Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California, USA
4 Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University Women's Health Center, Assiut, Egypt
5 Center for Population and Reproductive Health, College of Medicine/University College Hospital, University of Ibadan, Ibadan, Nigeria
6 Aminu Kano Teaching Hospital, Kano, Nigeria
7 Department of Obstetrics and Gynecology, Katsina General Hospital, Katsina, Nigeria
Reproductive Health 2010, 7:24 doi:10.1186/1742-4755-7-24
Published: 1 September 2010Abstract
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.