Abstract
BackgroundThe aim of this case series is to describe the experience of using the non-pneumatic anti-shock garment (NASG) in the management of severe Postpartum hemorrhage (PPH) and shock, and the value of implementing this concept in high-complexity obstetric hospitals.MethodsDescriptive case series of 77 women that received NASG in the management of PPH with severe hypovolemic shock from June 2014 to December 2015. Vital signs, shock index (SI), the lactic acid value and the base deficit were compared before and after NASG application.ResultsFifty-six (77%) women had an SI > 1.1 at the time shock management was initiated; 96% had uterine atony. All women received standard does of uterotonics. The average time between the birth and NASG applications was 20 min. Forty-eight percent of women recovered haemodynamic variables in the first hour and 100% within the first 6 h; 100% had a SI < 1.0 in the first hour. The NASG was not removed until definitive control of bleeding was achieved, with an average time of use of 24 h. There were no mortalities.ConclusionsIn this case series of women in severe shock, the NASG was an effective management device for the control of severe hypovolemic shock. It should be considered a first-line option for shock management.
Highlights
The aim of this case series is to describe the experience of using the non-pneumatic anti-shock garment (NASG) in the management of severe Postpartum hemorrhage (PPH) and shock, and the value of implementing this concept in high-complexity obstetric hospitals
In this study we report on the experience of using the NASG in the management of PPH and the value of implementing the device in obstetric units where high risk patients are managed
In 2015 in Colombia, where this study was conducted, the maternal mortality ratio (MMR) was 52 per 100 thousand live births [5], approximately 50% of deaths were due to hemorrhage; the majority of hemorrhage was due to postpartum hemorrhage (PPH) [6]
Summary
The aim of this case series is to describe the experience of using the non-pneumatic anti-shock garment (NASG) in the management of severe Postpartum hemorrhage (PPH) and shock, and the value of implementing this concept in high-complexity obstetric hospitals. The 2015 inter-agency report on maternal mortality established a global maternal mortality ratio (MMR) of 216 per 100 thousand live births. Ninety-nine percent of maternal deaths were concentrated in developing countries and hemorrhage was the principal cause of maternal mortality and morbidity in Latin America [1,2,3,4]. In 2015 in Colombia, where this study was conducted, the MMR was 52 per 100 thousand live births [5], approximately 50% of deaths were due to hemorrhage; the majority of hemorrhage was due to postpartum hemorrhage (PPH) [6]. With a loss of blood volume of 40%, hypovolemic shock, multiple organ dysfunction and global hypoxia develop, with severe metabolic damage. Shock becomes irreversible when hypothermia, coagulopathy, and metabolic acidosis (triad of death) are present [8]
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