Abstract
BackgroundPostpartum 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.MethodsThis 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.ResultsMeasured 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).ConclusionIn 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.
Highlights
Postpartum hemorrhage (PPH) is the leading cause of maternal mortality and severe maternal morbidity
A total of 854 women were included in the analysis of which 343 were in the pre-intervention phase and 511 in the Non-pneumatic Anti-Shock Garment (NASG) phase
There were no differences in condition on study entry, except that more women in the pre-intervention phase were transferred in bleeding than in the NASG phase (51.4% vs. 29.1%, p < 0.001)
Summary
Postpartum hemorrhage (PPH) is the leading cause of maternal mortality and severe maternal morbidity. Postpartum hemorrhage (PPH) is the single largest cause of maternal death worldwide. These deaths are largely preventable with skilled attendance and comprehensive emergency obstetric care. While the majority of maternal deaths from hemorrhage occur in low-resource settings, PPH-related mortality and morbidity are rising in higher-resource countries as well [1]. A woman suffering from PPH can die within 2 hours unless she receives immediate and appropriate medical care [2]. When a woman suffering from PPH arrives at a health facility, there may not be trained staff, essential supplies or medications available to treat her [3]
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