Abstract
IntroductionWomen with postpartum haemorrhage (PPH) in developing countries often present in critical condition when treatment might be insufficient to save lives. Few studies have shown that application of non-pneumatic anti-shock garment (NASG) could improve maternal survival.MethodsA systematic review of the literature explored the effect of NASG use compared with standard care for treating PPH. Medline, EMBASE and PubMed were searched. Methodological quality was assessed following the criteria suggested by the Cochrane Effective Practice and Organization of Care Group. Guidelines on Meta-analysis of Observational Studies in Epidemiology were used for reporting the results. Mantel-Haenszel methods for meta-analysis of risk ratios were used.ResultsSix out 31 studies met the inclusion criteria; only one cluster randomized controlled trial (c-RCT). Among observational studies, NASG fared better than standard care regarding maternal mortality reduction (Relative Risk (RR) 0.52 (95% Confidence interval (CI) 0.36 to 0.77)). A non-significant reduction of maternal mortality risk was observed in the c-RCT (RR: 0.43 (95% CI: 0.14 to 1.33)). No difference was observed between NASG use and standard care on use of blood products. Severe maternal outcomes were used as proxy for maternal death with similar pattern corroborating the trend towards beneficial effects associated with NASG.ConclusionNASG is a temporizing alternative measure in PPH management that shows a trend to reduce PPH-related deaths and severe morbidities. In settings where delays in PPH management are common, particularly where constraints to offer blood products and definitive treatment exist, use of NASG is an intervention that should be considered as a policy option while the standard conditions for care are being optimized.
Highlights
Women with postpartum haemorrhage (PPH) in developing countries often present in critical condition when treatment might be insufficient to save lives
An observational study suggested that non-pneumatic anti-shock garment (NASG) use adds some time for postpartum haemorrhage women until definitive treatment can be reached, especially in other aetiologies rather than ruptured uterus [9]
By systematically reviewing the available scientific evidence, we found that NASG may be able to temporarily mitigate the effects of blood loss after delivery
Summary
Women with postpartum haemorrhage (PPH) in developing countries often present in critical condition when treatment might be insufficient to save lives. Few studies have shown that application of non-pneumatic anti-shock garment (NASG) could improve maternal survival. In many settings around the world, delays during PPH prevention, diagnosis and treatment occur and contribute to avoidable maternal death and morbidity [5]. The Non-pneumatic Anti-Shock Garment (NASG) is a device developed as a temporizing measure to regain hemodynamic stability and allow patient transfer or definitive PPH treatment. An observational study suggested that NASG use adds some time for postpartum haemorrhage women until definitive treatment can be reached, especially in other aetiologies rather than ruptured uterus [9]. We conducted a systematic review to assess the effectiveness and safety of using NASG in improving maternal outcomes following severe PPH in settings where recourses are scare or definitive treatment to PPH may be delayed
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