title: Can the Non-pneumatic Anti-Shock Garment (NASG) reduce adverse maternal outcomes from postpartum hemorrhage? Evidence from Egypt and Nigeria.
abstract: BACKGROUND
  Postpartum hemorrhage (PPH) is the leading cause of maternal mortality and severe maternal morbidity. The Non-pneumatic Anti-Shock Garment (NASG), a first-aid lower-body compression device, may decrease adverse outcomes from obstetric hemorrhage. This article is the first to report the effect of the NASG for PPH.
  
  
  METHODS
  This pre-intervention/NASG study of 854 women was conducted in four referral facilities in Nigeria and two in Egypt between 2004-2008. Entry criteria were women with PPH due to uterine atony, retained placenta, ruptured uterus, vaginal or cervical lacerations or placenta accreta with estimated blood loss of ≥ 750 mL and one clinical sign of shock. Differences in demographics, conditions on study entry, treatment and outcomes were examined. The Wilcoxon rank-sum test and relative risks with 95% confidence intervals were calculated for primary outcomes - measured blood loss, emergency hysterectomy, mortality, morbidity (each individually), and a combined variable, "adverse outcomes", defined as severe morbidity and mortality. A multiple logistic regression model was fitted to test the independent association between the NASG and the combined severe morbidity and mortality outcome.
  
  
  RESULTS
  Measured blood loss decreased by 50% between phases; women experienced 400 mL of median blood loss after study entry in the pre-intervention and 200 mL in the NASG phase (p < 0.0001). As individual outcomes, mortality decreased from 9% pre-intervention to 3.1% in the NASG phase (RR 0.35, 95% CI 0.19-0.62); severe morbidity decreased from 4.2% to 1%, in the NASG phase (RR 0.24, 95% CI 0.09-0.67). As a combination, "adverse outcomes," decreased from 12.8% to 4.1% in the NASG phase (RR 0.32, 95% CI 0.19-0.53). In a multiple logistic regression model, the NASG was associated with the combined outcome of severe maternal morbidity and mortality (OR 0.42, 95% CI 0.18-0.99).
  
  
  CONCLUSIONS
  In this non-randomized study, in which bias is inherent, the NASG showed promise for reducing blood loss, emergency hysterectomy, morbidity and mortality associated with PPH in referral facilities in Egypt and Nigeria.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California, USA. suellenmiller@gmail.com.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Mourad-Youssif
authors.forename: Oladosu A
authors.initials: OA
authors.lastname: Ojengbede
authors.forename: Carinne D
authors.initials: CD
authors.lastname: Meyer
authors.forename: Mohammad
authors.initials: M
authors.lastname: Fathalla
authors.forename: Imran O
authors.initials: IO
authors.lastname: Morhason-Bello
authors.forename: Hadiza
authors.initials: H
authors.lastname: Galadanci
authors.forename: Carol
authors.initials: C
authors.lastname: Camlin
authors.forename: David
authors.initials: D
authors.lastname: Nsima
authors.forename: Tarek
authors.initials: T
authors.lastname: Al Hussaini
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Butrick
authors.forename: Suellen
authors.initials: S
authors.lastname: Miller
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