Application Of Non-pneumatic Anti-shock Garment Research Articles

Predictors of time to recovery from postpartum hemorrhage in Debre Markos comprehensive specialized hospital, Northwest, Ethiopia, 2020/21

BackgroundPostpartum hemorrhage is one of the leading causes of maternal deaths worldwide. Early recovery is a performance indicator and better health outcome of patients with postpartum hemorrhage. Therefore, this study aimed to assess time to recovery from postpartum hemorrhage and its predictors in Debre Markos Comprehensive Specialized Hospital, Ethiopia, 2020.MethodsA retrospective follow-up study was conducted among 302 women who were diagnosed with postpartum hemorrhage from January 1, 2016 to December 31, 2020 at Debre Markos Comprehensive Specialized Hospital. Consecutive sampling technique was employed. To show the statistical significant difference between each group of variables, log rank test was used. Kaplan Meier analysis to estimate time to recovery and cox proportional-hazard regression analysis to determine independent predictors were carried out cautiously. Adjusted hazard ratio used to determine the strength of association.ResultThe median recovery time from postpartum hemorrhage was 13 h with range of (10 to 17 h). Blood transfusion (AHR: 1.8, 95% CI (1.39, 2.57)), NASG utilization (AHR: 6.5, 95% CI (4.58, 9.42)) fluid resuscitation (AHR 2.9, 95% CI (1.48, 5.54)), active management of third stage of labor (AHR: 1.7, 95% CI (1.18, 2.45)) and history of antenatal care follow-up (AHR: 2.6, 95% CI (1.91, 3.56)) were the predictors, which shorten the recovery time. Comorbidities like anemia at the time of admission (AHR: 0.62 95% CI (0.44, 0.89)), retroviral infection (AHR: 0.33, 95% CI (0.16, 0.67)) and Hepatitis B-Virus infection (AHR: 0.52, 95% CI (0.32, 0.82)) delay the recovery rate from postpartum hemorrhage.ConclusionMothers in North-West Ethiopia stays morbid from postpartum hemorrhage for more than half a day. Their recovery time was affected by Non-Pneumatic Anti-Shock Garment utilization, implementation of emergency management components like blood transfusion and fluid resuscitation, history of antenatal care follow up, and being comorbid with viral infections. Non-pneumatic anti-shock garment application to every mother with postpartum hemorrhage and implementation of proper emergency management approach are vital for rapid recovery from postpartum hemorrhage.

Effectiveness of Non-pneumatic Anti-shock Garment (NASG) in Preventing Shock-related Morbidity and Mortality in Severe Hemorrhagic Shock

Context: NASG is a first-aid-life-sustaining-device that supports the life of a patient in hemorrhagic shock during delays in receiving appropriate healthcare services by shunting blood from the lower body to the core organs. Objectives: To reappraisal the effectiveness of NASG in sustaining life, and preventing shock-related morbidity and mortality during obstetric delays and make recommendations. Method: The case notes of 4 patients that were managed with NASG in Enugu State University Teaching Hospital (ESUTH), Enugu from July 25, 2016 to April 3, 2017 were reviewed and the results presented in tables and percentages. Results: The mean age and parity of the patients were 31.8 years and 3.5 respectively. They presented in severe hemorrhagic shock with 2/4 (50%) unconscious, 2/4 (50%) pulseless, and low mean arterial pressures. The two unconscious patients became conscious with the restoration of pulses on the application of NASG. The vital signs of the patients improved when the causes of shock were properly treated. Uterine rupture ¾ (75%), vaginal lacerations 1/4(20%) and cervical tear ¼ (25%) accounted for the hemorrhagic shock in this reappraisal. A total of 23 pints of blood were transfused. All the patients survived and none had shock-related morbidity. Conclusions: This reappraisal has confirmed the effectiveness of NASG in preventing shock-related complications during obstetric delays. The causes of the shock must be identified and properly treated to optimize its effectiveness. NASG should be available in every childbirth center.

Non-pneumatic anti-shock garment for improving maternal survival following severe postpartum haemorrhage: a systematic review.

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.

Cost-effectiveness of the non-pneumatic anti-shock garment (NASG): evidence from a cluster randomized controlled trial in Zambia and Zimbabwe.

BackgroundObstetric hemorrhage is the leading cause of maternal mortality, particularly in low resource settings where delays in obtaining definitive care contribute to high rates of death. The non-pneumatic anti-shock garment (NASG) first-aid device has been demonstrated to be highly cost-effective when applied at the referral hospital (RH) level. In this analysis we evaluate the incremental cost-effectiveness of early NASG application at the Primary Health Center (PHC) compared to later application at the RH in Zambia and Zimbabwe.MethodsWe obtained data on health outcomes and costs from a cluster-randomized clinical trial (CRCT) and participating study hospitals. We translated health outcomes into disability-adjusted life years (DALYs) using standard methods. Econometric regressions estimated the contribution of earlier PHC NASG application to DALYs and costs, varying geographic covariates (country, referral hospital) to yield regression models best fit to the data. We calculated cost-effectiveness as the ratio of added costs to averted DALYs for earlier PHC NASG application compared to later RH NASG application.ResultsOverall, the cost-effectiveness of early application of the NASG at the primary health care level compared to waiting until arrival at the referral hospital was $21.78 per DALY averted ($15.51 in added costs divided by 0.712 DALYs averted per woman, both statistically significant). By country, the results were very similar in Zambia, though not statistically significant in Zimbabwe. Sensitivity analysis suggests that results are robust to a per-protocol outcome analysis and are sensitive to the cost of blood transfusions.ConclusionsEarly NASG application at the PHC for women in hypovolemic shock has the potential to be cost-effective across many clinical settings. The NASG is designed to reverse shock and decrease further bleeding for women with obstetric hemorrhage; therefore, women who have received the NASG earlier may be better able to survive delays in reaching definitive care at the RH and recover more quickly from shock, all at a cost that is highly acceptable.

Per-protocol effect of earlier non-pneumatic anti-shock garment application for obstetric hemorrhage

Obstetric hemorrhage is the primary cause of maternal mortality worldwide, especially in lower-resource settings that are characterized by treatment delays [1]. The non-pneumatic anti-shock garment (NASG) is a first-aid device used to stabilize women in shock from obstetric hemorrhage until they can receive definitive care. The authors conducted a cluster-randomized trial (CRT) to evaluate NASG application at the primary health clinic prior to referral hospital transfer on maternal outcomes. Control participants received the NASG upon arrival at the referral hospital. The intent-to-treat analysis (ITT) reported a non-statistically significant 46% reduction in mortality, 54% reduction in extreme adverse outcomes, and a significant 25% faster recovery from shock associated with earlier NASG intervention [2]. However, protocol violations occurred, potentially diluting the intervention effect. Thus, the effect of earlier NASG application was evaluated using 2 per-protocol analysis strategies.

Midwives’ Knowledge and Utilization of Anti-Shock Garment In Prevention of Postpartum Haemorrhage Shock at the University College Hospital, Ibadan Nigeria.

Postpartum Haemorrhage is the most common cause of maternal mortality in world. It is vaginal bleeding in excess of 500ml after vaginal delivery or in excess of 1000ml after cesarean delivery that can jeopardize the survival of client. The purpose of the study therefore, is to determine the midwives' knowledge on utilization of anti-shock garment in the prevention of postpartum haemorrhage shock in the University College Hospital, Ibadan Nigeria. Through incidental and purposive sampling methods, 110 respondents were selected for the study. Data collection was carried out from 19 th to 29 th October, 2011 with self-developed structured questionnaire. However, only 100 returned a fully completed questionnaire which was analyzed using Microsoft Excel. 2010 edition. Ages of the respondents ranged from 20 to 59 with a mean 31± 2.6 and 100% of the midwives are females. The respondents' years of experience as midwives ranged from 1 to 27 with a mean 13 ± 5.9. Respondents held different views on the number of emergency cases of post partum haemorrhage referred weekly to UCH, Ibadan from other hospitals. The results revealed that 7% of them had no idea of the number, 46% said it is 10-20, 34% believed it is 21-30 while 13% believed it is >30. Awareness about the existence of non-pneumatic anti-shock garment (NASG) was high among the respondents as 96% of them said they have heard about it through various sources ranging from seminars and conferences (60%), textbook (16%), journals (11%), internet (7%) and electronic media (2%). As much as 76% of them could describe NASG application, removal and its general function in the prevention of post partum haemorrhage. Similarly, majority (74%) could correctly explain various advantage of NASG as well as some maternal and fetal conditions that are contraindicated in the use of NASG. However, their knowledge seems to be only theoretical as only 35% of them have had opportunities to apply NASG; the rest 65% had never applied it on clients. Because the respondents have never had opportunity to apply NASG on bleeding woman, their theoretical knowledge is of little use. Therefore it was recommended that the authority of the UCH, Ibadan should make NASG abundantly available for the use of its personnel. Also since the survival of the patient is the utmost goal of any hospital, application of NASG should not be limited to resident doctors and consultant obstetricians and gnaecologists alone; the midwife as a stake holder in midwifery matter should be given free hands to apply it on bleeding woman. Keywords: Midwives, Post-partum Haemorrhage, Mortality, Pneumatic Anti-shock Garment, Anyone,

The Non-pneumatic Anti-Shock Garment: How Applier Strength and Body Mass Index Affect External Abdominal Pressure

Objective: To assess the amount of abdominal pressure generated by the Non-pneumatic Anti-Shock Garment (NASG), a first-aid counter pressure device for obstetric hemorrhage, and to evaluate if body mass index (BMI) and ap- plier strength, affect pressure. Study Design: A pilot study convenience sample of 20 non-pregnant volunteers underwent external abdominal pressure monitoring with NASG placement. Mean pressure and the effects of BMI and applier strength were examined. Results: The mean external abdominal pressure significantly increased from 1.0 mmHg at baseline to 67 mmHg on NASG application, returning to 1.0 mmHg upon removal (p=0.005). Greater mean pressure was exerted by a strong applier ver- sus a weak applier, irrespective of BMI (p<0.001). Pressure had an inverse relationship with BMI, particularly with a strong applier (r=-0.905, p<0.001). The difference between pressures achieved in an underweight patient with a strong ap- plier and an overweight patient with a weak applier was significant (73.2 vs 35.7 mmHg; p=0.051). Conclusion: This pilot study demonstrates a significant increase in abdominal pressure with device application and sig- nificant variation with BMI and applier strength. These findings may have important implications for optimizing device usage.

Impact of the Non-pneumatic Antishock Garment on pelvic blood flow in healthy postpartum women

The Non-pneumatic Antishock Garment (NASG) is a compression device that has shown significantly decreased blood loss in cases of obstetric hemorrhage. However, there are no physiologic studies of the NASG in postpartum women. This study used Doppler ultrasound to measure the resistive index (RI) in the internal iliac artery, thus approximating blood flow to the pelvis with and without the garment applied. In this study, RI of the internal iliac artery was measured in a sample of 10 postpartum volunteers with and without the NASG applied. Median RI was calculated and compared between baseline and full application. Internal iliac artery median RI was 0.83 (SD 0.11) at baseline and increased to 1.05 (SD 0.15) with full NASG application (P = .02). This study suggests a significant increase in internal iliac artery RI with NASG application and provides a physiological explanation of how the NASG might reduce postpartum hemorrhage.