title: Assessing the role of the non-pneumatic anti-shock garment in reducing mortality from postpartum hemorrhage in Nigeria.
abstract: OBJECTIVE
  Postpartum hemorrhage (PPH) is the leading cause of maternal mortality. The non-pneumatic anti-shock garment (NASG), a first-aid lower-body pressure device, may decrease mortality.
  
  
  METHODS
  This pre-intervention/NASG study of 288 women was conducted in four referral facilities in Nigeria, 2004-2008. Entry criteria: 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. t tests and relative risks with 95% confidence intervals were calculated for primary outcomes - measured blood loss and mortality. Multiple logistic regression analysis was performed to examine independent association of the NASG with mortality.
  
  
  RESULTS
  Mean measured blood loss decreased by 80% between phases. Women experienced 350 ml of median blood loss after study entry in the pre-intervention and 50 ml in the NASG phase (p < 0.0001). Mortality decreased from 18% pre-intervention to 6% in the NASG phase (RR = 0.31, 95% CI 0.15-0.64, p = 0.0007). In a multiple logistic regression model, the NASG was associated with reduced mortality (odds ratio 0.30; 95% CI 0.13-0.68, p = 0.004).
  
  
  CONCLUSIONS
  The NASG shows promise for reducing mortality from PPH in referral facilities in Nigeria.
authors.affiliation: Center for Population and Reproductive Health, College of Medicine/University College Hospital, University of Ibadan, Ibadan, Nigeria.
authors.forename: Oladosu A
authors.initials: OA
authors.lastname: Ojengbede
authors.forename: Imran Oludare
authors.initials: IO
authors.lastname: Morhason-Bello
authors.forename: Hadiza
authors.initials: H
authors.lastname: Galadanci
authors.forename: Carinne
authors.initials: C
authors.lastname: Meyer
authors.forename: David
authors.initials: D
authors.lastname: Nsima
authors.forename: Carol
authors.initials: C
authors.lastname: Camlin
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Butrick
authors.forename: Suellen
authors.initials: S
authors.lastname: Miller
mesh_terms: D000328:Adult; D001794:Blood Pressure; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005392:First Aid / Q000295:instrumentation*; D005676:Gravity Suits; D006801:Humans; D016015:Logistic Models; D008428:Maternal Mortality; D009017:Morbidity; D009549:Nigeria; D010865:Pilot Projects; D006473:Postpartum Hemorrhage / Q000401:mortality* / Q000628:therapy*; D011247:Pregnancy; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult