Obstetric hemorrhage and shock management: using the low technology Non-pneumatic Anti-Shock Garment in Nigerian and Egyptian tertiary care facilities.
BACKGROUND
Obstetric hemorrhage is the leading cause of maternal mortality globally. The Non-pneumatic Anti-Shock Garment (NASG) is a low-technology, first-aid compression device which, when added to standard hypovolemic shock protocols, may improve outcomes for women with hypovolemic shock secondary to obstetric hemorrhage in tertiary facilities in low-resource settings.


METHODS
This study employed a pre-intervention/intervention design in four facilities in Nigeria and two in Egypt. Primary outcomes were measured mean and median blood loss, severe end-organ failure morbidity (renal failure, pulmonary failure, cardiac failure, or CNS dysfunctions), mortality, and emergency hysterectomy for 1442 women with ≥750 mL blood loss and at least one sign of hemodynamic instability. Comparisons of outcomes by study phase were assessed with rank sum tests, relative risks (RR), number needed to treat for benefit (NNTb), and multiple logistic regression.


RESULTS
Women in the NASG phase (n = 835) were in worse condition on study entry, 38.5% with mean arterial pressure <60 mmHg vs. 29.9% in the pre-intervention phase (p = 0.001). Despite this, negative outcomes were significantly reduced in the NASG phase: mean measured blood loss decreased from 444 mL to 240 mL (p < 0.001), maternal mortality decreased from 6.3% to 3.5% (RR 0.56, 95% CI 0.35-0.89), severe morbidities from 3.7% to 0.7% (RR 0.20, 95% CI 0.08-0.50), and emergency hysterectomy from 8.9% to 4.0% (RR 0.44, 0.23-0.86). In multiple logistic regression, there was a 55% reduced odds of mortality during the NASG phase (aOR 0.45, 0.27-0.77). The NNTb to prevent either mortality or severe morbidity was 18 (12-36).


CONCLUSIONS
Adding the NASG to standard shock and hemorrhage management may significantly improve maternal outcomes from hypovolemic shock secondary to obstetric hemorrhage at tertiary care facilities in low-resource settings.
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, USA. suellenmiller@gmail.com
Suellen
S
Miller
Mohamed M F
MM
Fathalla
Oladosu A
OA
Ojengbede
Carol
C
Camlin
Mohammed
M
Mourad-Youssif
Imran O
IO
Morhason-Bello
Hadiza
H
Galadanci
David
D
Nsima
Elizabeth
E
Butrick
Tarek
T
Al Hussaini
Janet
J
Turan
Carinne
C
Meyer
Hilarie
H
Martin
Aminu I
AI
Mohammed
D003020:Clothing; D004534:Egypt; D005260:Female; D006268:Health Facilities; D006295:Health Resources; D006801:Humans; D008428:Maternal Mortality; D009549:Nigeria; D007744:Obstetric Labor Complications / Q000097:blood / Q000628:therapy*; D011247:Pregnancy; D012769:Shock / Q000628:therapy*; D014592:Uterine Hemorrhage / Q000628:therapy*