Non-pneumatic Anti-shock Garment Research Articles

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.

Nonpneumatic antishock garment combined with bakri balloon as a nonoperative "uterine sandwich" for temporization of massive postpartum hemorrhage from disseminated intravascular coagulation.

Disseminated intravascular coagulation (DIC) is an uncommon but potentially catastrophic complication of postpartum hemorrhage. We describe two cases of massive postpartum hemorrhage complicated by DIC that were successfully temporized with combined use of the Bakri balloon and nonpneumatic antishock garment (NASG) during massive transfusion. In the first case, a healthy, term gravida underwent emergent cesarean for fetal bradycardia during labor induction. 10 minutes after completion of surgery, brisk vaginal hemorrhage of nonclotting blood from fulminant DIC resulted in maternal shock. A Bakri balloon and NASG were placed during massive transfusion, resulting in rapid maternal stabilization. In the second case, a healthy, term gravida suffered an amniotic fluid embolism during labor requiring emergent cesarean delivery and complicated by cardiac arrest with successful resuscitation. Postoperative rapid uterine bleeding from DIC was treated with a Bakri balloon and NASG, stabilizing the patient during massive transfusion. Neither patient required further surgical procedures. NASG combined with Bakri balloon may serve as a valuable nonoperative treatment or temporization option in cases of massive postpartum hemorrhage complicated by coagulopathy such as these. Further study of the utility of NASG in high-resource settings is warranted.

Non-pneumatic anti-shock garment to stabilize women with hypovolemic shock secondary to obstetric hemorrhage

Non-pneumatic anti-shock garment to stabilize women with hypovolemic shock secondary to obstetric hemorrhage

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,

Availability, And Awareness of Non-Pneumatic Antishock Garment in Tertiary Hospitals of Northern Nigeria

Background: The (NASG) was introduced as a gadget that can be used for first aid treatment of women in postpartum shock prior to proper investigation and appropriate management of the patient. Purpose of the study: aims at assessing the availability, awareness and utilization of non-pneumatic Antishock garment in tertiary hospitals of Northern Nigeria. That is the North West, North East and North central. Materials and methods: A descriptive design was used .Isaac & Michael, (1981); Smith, (1983) sample size chart revealed that for a given population of 100,000 and above the sample size for such population should be 398. A four point level likert scale questionnaire was structured. The data collected was analysed using one way analysis of variance (ANOVA) and with a 0.05 level of confidence to answer the hypotheses. A constant mean of 2.5 was used to ascertain the agreement of the respondents on the questionnaire items. Results of the study, revealed that, NASG is available in the selected hospitals but strictly within the control of the hospitals’ management in Northern Nigeria with an aggregate mean score of 2.32 .Nurses and doctors in tertiary hospitals in Northern Nigeria are aware of the NASG for postpartum haemorrhage with an aggregate mean score of3.18. There is significant difference in the availability and awareness of the NASG for postpartum haemorrahage among nurses and doctors of the selected tertiary hospitals in Northern Nigeria. Conclusion: the NASG is available strictly in tertiary hospitals in Northern Nigeria and doctors and nurses are

Combined analysis of the non-pneumatic anti-shock garment on mortality from hypovolemic shock secondary to obstetric hemorrhage.

BackgroundObstetric hemorrhage is the leading cause of maternal mortality, particularly in low-resource settings where women face significant delays in accessing definitive treatment. The Non-pneumatic Anti-Shock Garment (NASG) is a first-aid device to stabilize women in hypovolemic shock secondary to obstetric hemorrhage. Prior studies on the effectiveness of the NASG have suffered from small sample sizes and insufficient statistical power. We sought to generate a summary effect estimate of this intervention by combining data from all previous quasi-experimental studies.MethodsFive quasi-experimental studies that tested the NASG as treatment for hypovolemic shock secondary to obstetric hemorrhage at the tertiary care facility level were included in the analysis. We evaluated heterogeneity of effect across studies and calculated pooled odds ratios. We also conducted a subgroup analysis among women in the most severe condition.ResultsParticipant characteristics were similar across studies with some variation in hemorrhage etiology. Median blood loss was at least 50% lower in the intervention group than the control group. The pooled odds ratio suggested that NASG intervention was associated with a 38% significantly reduced odds of mortality among the overall sample, and a 59% significantly reduced odds of mortality among the most severe women.ConclusionsThe results from this combined analysis suggest that NASG intervention is associated with a reduced odds of death for women with hypovolemic shock secondary to obstetric hemorrhage. Further research should focus on application of the NASG at the community or primary health care level, and utilize a more robust methodology.

Non-Pneumatic Anti-Shock Garment (NASG), a First-Aid Device to Decrease Maternal Mortality from Obstetric Hemorrhage: A Cluster Randomized Trial

BackgroundObstetric hemorrhage is the leading cause of maternal mortality. Using a cluster randomized design, we investigated whether application of the Non-pneumatic Anti-Shock Garment (NASG) before transport to referral hospitals (RHs) from primary health care centers (PHCs) decreased adverse outcomes among women with hypovolemic shock. We hypothesized the NASG group would have a 50% reduction in adverse outcomes.Methods and FindingsWe randomly assigned 38 PHCs in Zambia and Zimbabwe to standard obstetric hemorrhage/shock protocols or the same protocols plus NASG prior to transport. All women received the NASG at the RH. The primary outcomes were maternal mortality; severe, end-organ failure maternal morbidity; and a composite mortality/morbidity outcome, which we labeled extreme adverse outcome (EAO). We also examined whether the NASG contributed to negative side effects and secondary outcomes. The sample size for statistical power was not reached; of a planned 2400 women, 880 were enrolled, 405 in the intervention group. The intervention was associated with a non-significant 46% reduced odds of mortality (OR 0.54, 95% CI 0.14–2.05, p = 0.37) and 54% reduction in composite EAO (OR 0.46, 95% CI 0.13–1.62, p = 0.22). Women with NASGs recovered from shock significantly faster (HR 1.25, 95% CI 1.02–1.52, p = 0.03). No differences were observed in secondary outcomes or negative effects. The main limitation was small sample size.ConclusionsDespite a lack of statistical significance, the 54% reduced odds of EAO and the significantly faster shock recovery suggest there might be treatment benefits from earlier application of the NASG for women experiencing delays obtaining definitive treatment for hypovolemic shock. As there are no other tools for shock management outside of referral facilities, and no safety issues found, consideration of NASGs as a temporizing measure during delays may be warranted. A pragmatic study with rigorous evaluation is suggested for further research.Trial RegistrationClinicalTrials.gov NCT00488462

Comorbidities and lack of blood transfusion may negatively affect maternal outcomes of women with obstetric hemorrhage treated with NASG.

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.

Use of the Non-Pneumatic Anti-Shock Garment (NASG) for Life-Threatening Obstetric Hemorrhage: A Cost-Effectiveness Analysis in Egypt and Nigeria

ObjectiveTo assess the cost-effectiveness of a non-pneumatic anti-shock garment (NASG) for obstetric hemorrhage in tertiary hospitals in Egypt and Nigeria.MethodsWe combined published data from pre-intervention/NASG-intervention clinical trials with costs from study sites. For each country, we used observed proportions of initial shock level (mild: mean arterial pressure [MAP] >60 mmHg; severe: MAP ≤60 mmHg) to define a standard population of 1,000 women presenting in shock. We examined three intervention scenarios: no women in shock receive the NASG, only women in severe shock receive the NASG, and all women in shock receive the NASG. Clinical data included frequencies of adverse health outcomes (mortality, severe morbidity, severe anemia), and interventions to manage bleeding (uterotonics, blood transfusions, hysterectomies). Costs (in 2010 international dollars) included the NASG, training, and clinical interventions. We compared costs and disability-adjusted life years (DALYs) across the intervention scenarios.ResultsFor 1000 women presenting in shock, providing the NASG to those in severe shock results in decreased mortality and morbidity, which averts 357 DALYs in Egypt and 2,063 DALYs in Nigeria. Differences in use of interventions result in net savings of $9,489 in Egypt (primarily due to reduced transfusions) and net costs of $6,460 in Nigeria, with a cost per DALY averted of $3.13. Results of providing the NASG for women in mild shock has smaller and uncertain effects due to few clinical events in this data set.ConclusionUsing the NASG for women in severe shock resulted in markedly improved health outcomes (2–2.9 DALYs averted per woman, primarily due to reduced mortality), with net savings or extremely low cost per DALY averted. This suggests that in resource-limited settings, the NASG is a very cost-effective intervention for women in severe hypovolemic shock. The effects of the NASG for mild shock are less certain.

O123 CHALLENGES: CLUSTER RANDOMIZED TRIAL (CRT) OF THE NON-PNEUMATIC ANTI-SHOCK GARMENT (NASG)

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S303-S304 Free communication (oral) presentations O123 CHALLENGES: CLUSTER RANDOMIZED TRIAL (CRT) OF THE NON-PNEUMATIC ANTI-SHOCK GARMENT (NASG) E. Butrick, E. ButrickSearch for more papers by this authorG. Mkumba, G. MkumbaSearch for more papers by this authorT.L. Magwali, T.L. MagwaliSearch for more papers by this authorV. Mambo, V. MamboSearch for more papers by this authorR. Amafumba, R. AmafumbaSearch for more papers by this authorK. McDonald, K. McDonaldSearch for more papers by this authorJ. DeMulder, J. DeMulderSearch for more papers by this authorS. Miller, S. MillerSearch for more papers by this author E. Butrick, E. ButrickSearch for more papers by this authorG. Mkumba, G. MkumbaSearch for more papers by this authorT.L. Magwali, T.L. MagwaliSearch for more papers by this authorV. Mambo, V. MamboSearch for more papers by this authorR. Amafumba, R. AmafumbaSearch for more papers by this authorK. McDonald, K. McDonaldSearch for more papers by this authorJ. DeMulder, J. DeMulderSearch for more papers by this authorS. Miller, S. MillerSearch for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)60553-0AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S303-S304 RelatedInformation

Nurses in Low Resource Settings Save Mothers' Lives With Non-pneumatic Anti-Shock Garment

To discuss the role of nurses and nurse-midwives in preventing and treating postpartum hemorrhage (PPH) from uterine atony in developing countries and examine the role of a new device, the non-pneumatic anti-shock garment (NASG), in improving the outcomes for these patients. In this subanalysis of a larger preintervention phase/intervention phase study of 1,442 women with obstetric hemorrhage, postpartum women with hypovolemic shock (N = 578) from uterine atony (≥750 mL blood loss; systolic blood pressure <100 mmHg and/or pulse >100 beats per minute) were enrolled in two referral facilities in Egypt and four referral facilities in Nigeria. The study had two temporal phases: a preintervention phase and an NASG-intervention phase. Women with hemorrhage and shock in both phases were treated with the same evidence-based protocols for management of hypovolemic shock and hemorrhage, but women in the NASG-intervention phase also received the NASG. Relative risks (RRs) with 95% confidence intervals (CIs) were estimated for primary outcomes-measured blood loss, incidence of emergency hysterectomy, and mortality. Women in the NASG-intervention phase had significantly better outcomes, 50% lower blood loss, reduced rates of hysterectomy (8.9% vs. 4%), and mortality decreased from 8.5% to 2.3% (RR = 0.27, 95% CI: 0.12-0.60). In low-resource settings nurses have few resources with which to stabilize women with severe PPH. With training nurses and nurse-midwives can stabilize hemorrhaging women with the NASG, a low-technology first-aid device that shows promise for reducing blood loss, rates of hysterectomy, and mortality.

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

Impact of the Non-Pneumatic Antishock Garment on Pelvic Blood Flow in Healthy Postpartum Women

Nonatonic Obstetric Haemorrhage: Effectiveness of the Nonpneumatic Antishock Garment in Egypt

The study aims to determine if the nonpneumatic antishock garment (NASG), a first aid compression device, decreases severe adverse outcomes from nonatonic obstetric haemorrhage. Women with nonatonic aetiologies (434), blood loss > 1000 mL, and signs of shock were eligible. Women received standard care during the preintervention phase (226) and standard care plus application of the garment in the NASG phase (208). Blood loss and extreme adverse outcomes (EAO-mortality and severe morbidity) were measured. Women who used the NASG had more estimated blood loss on admission. Mean measured blood loss was 370 mL in the preintervention phase and 258 mL in the NASG phase (P < 0.0001). EAO decreased with use of the garment (2.9% versus 4.4%, (OR 0.65, 95% CI 0.24–1.76)). In conclusion, using the NASG improved maternal outcomes despite the worse condition on study entry. These findings should be tested in larger studies.

The non-pneumatic anti-shock garment for postpartum haemorrhage in nigeria

Objective: This study examines whether the non-pneumatic anti-shock garment (NASG) reduces blood loss and mortality from uterine atony. Method: The sample was taken from delivering women at four referral facilities in nigeria who suffered obstetric haemorrhage, from which a subset of women with aetiology of post-partum uterine atony were examined. Data were collected by hospital staff and included 139 women, 54 in the pre-intervention phase and 85 in the NASG intervention phase. Differences in demographics, condition on study entry, treatment and outcomes were examined. Relative risks and 95% confidence intervals were used for primary outcomes of blood loss and mortality. Results: Median measured blood loss decreased from 360 ml pre-intervention to 30 ml in the NASG phase (P &lt; 0.001). Mortality was reduced 72% for women treated with the NASG from 16.7% pre-intervention to 4.7% during the NASG phase (relative risk = 0.28, 95% confidence interval 0.09–0.87). Conclusion: The NASG shows promise for reducing blood loss and death from haemorrhage and shock due to uterine atony.

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.

Treating uterine atony with the non-pneumatic anti-shock garment in Egypt

Objective: To determine whether the non-pneumatic anti-shock garment (NASG) reduces maternal morbidity and mortality from uterine atony. Method: Women with uterine atony (blood loss of ≥1000 ml) and one clinical sign of shock were enrolled in a pre-intervention phase (n=169) and an intervention phase (n=269) at two referral facilities in Egypt. Differences in demographics, condition on study entry, treatment, and outcomes were examined. Relative risks and 95% confidence intervals (CI) were estimated for mean measured blood loss, emergency hysterectomy, and extreme adverse outcomes (EAO)—a combination of morbidity and mortality. Results: in the intervention phase, mean measured blood loss was significantly reduced, emergency hysterectomy was significantly decreased, and there were fewer EAOs (11% to 3% in the NASG phase, relative risk=0.28, 95% CI: 0.12–0.63). A subgroup analysis of only women in severe shock demonstrated similar trends. Conclusion: The NASG shows promise for reducing blood loss, emergency hysterectomies, and EAO from obstetric haemorrhage-related shock due to uterine atony.

Positive Effects of the Non-pneumatic Anti-shock Garment on Delays in Accessing Care for Postpartum and Postabortion Hemorrhage in Egypt and Nigeria

We examined whether the non-pneumatic anti-shock garment (NASG) ameliorates the effects of delays in transport to and treatment at hospitals for women with postpartum hemorrhage (PPH) and postabortion hemorrhage (PAH) and investigated the effects of NASG use on timing of delivery of interventions in-hospital. Pre/post studies of the NASG were conducted at hospitals in Cairo (n = 349 women), Assuit (n = 274), Southern Nigeria (n = 57), and Northern Nigeria (n = 124). In post-hoc analyses, comparisons of delays were conducted using analysis of variance (ANOVA), and associations of delays with extreme adverse outcomes (EAO, mortality or severe morbidity) were examined using chi-square tests, odds ratios (ORs), and multivariate logistic regression. Median minutes from hemorrhage start to study admission differed by site, ranging from 15 minutes in Cairo to 225 minutes in Northern Nigeria (p < 0.001). Median minutes from study admission to blood transfusion ranged from 30 minutes in Cairo to 209 minutes in Southern Nigeria (p < 0.001). Twenty percent of women with ≥60 minutes between hemorrhage start and study admission experienced an EAO without the NASG compared with only 6% with the NASG (χ(2) = 13.71, p < 0.001). In-hospital delays in receiving intravenous (IV) fluids and blood were more common in the NASG phase. Women with PPH or PAH in Egypt and Nigeria often face delays in reaching emergency obstetrical care facilities and delays in receiving definitive therapies after arrival. Our results indicate that the NASG can reduce the impact of these delays. Stabilization does not replace treatment, however, and delays in fluid/blood administration with NASG use must be avoided.