Abstract
The Non-Pneumatic Anti-Shock Garment (NASG) is a first-aid device to reduce mortality from severe obstetric hemorrhage, the leading cause of maternal mortality globally. We sought to evaluate patient characteristics associated with mortality among a cohort of women treated with the NASG in Nigeria. Data on 1,149 women were collected from 50 facilities participating in the Pathfinder International Continuum of Care: Addressing Postpartum Hemorrhage project in Nigeria from 2007–2012. Characteristics were compared using the appropriate distributional tests, and we estimated multivariable logistic regression models to control for treatment received. There were 201 deaths (17.5%). Women who died were significantly more likely to have any co-morbidity (AOR 3.63, 95% CI: 2.41–5.48), ruptured uterus (AOR 2.79, 95% CI: 1.48–5.28), macerated stillbirth (AOR 2.96, 95% CI 1.60–5.48) and to have had 6 or more previous births, (AOR 1.53, 95% CI 1.11–2.12), after adjusting for treatment received. These results suggest certain maternal conditions, particularly the presence of another life-threatening co-morbidity or macerated stillbirth, conferred a higher risk of mortality from PPH. This underscores the need for multi-system assessment and a comprehensive approach to the treatment of women with pregnancy complications.
Highlights
Obstetric hemorrhage (OH) is the leading cause of maternal mortality globally, responsible for at least 25% of the 287,000 maternal deaths estimated to occur annually [1,2]
Women with postpartum hemorrhage (PPH) and hypovolemic shock were treated with a standard hypovolemic shock and hemorrhage protocol, in addition to receiving the Non-Pneumatic Anti-Shock Garment (NASG) [19]
Mortality was significantly associated with ruptured uterus (AOR 2.79, 95% CI 1.48–5.28), macerated stillbirth (AOR 2.96, 95% CI 1.60–5.48) and high gravidity (AOR 1.53, 95% CI 1.11– 2.12). These results suggest that certain characteristics or conditions of the woman and of the health care system are associated with the risk of death from obstetric hemorrhage despite application of the NASG
Summary
Obstetric hemorrhage (OH) is the leading cause of maternal mortality globally, responsible for at least 25% of the 287,000 maternal deaths estimated to occur annually [1,2]. Most of these deaths occur postpartum, and are due to uterine atony [3]. Active management of third-stage labor (AMTSL), the administration of prophylactic uterotonics, will prevent 20–60% of atonic postpartum hemorrhage (PPH) [4,5]. Treatment protocols include rapid administration of intravenous crystalloid fluid, uterotonics, bimanual uterine massage, manual removal of the placenta, repair of lacerations, blood transfusion and surgery [8]
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