Nurses in low resource settings save mothers' lives with non-pneumatic anti-shock garment.
OBJECTIVE
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.


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Safe Motherhood Program, Department of Obstetrics, Gynecology and Reproductive Sciences at University of California, San Francisco, CA, USA.
Farah
F
Kausar
Jessica L
JL
Morris
Mohamed
M
Fathalla
Oladosu
O
Ojengbede
Adetokunbo
A
Fabamwo
Mohammed
M
Mourad-Youssif
Imran O
IO
Morhason-Bello
Hadiza
H
Galadanci
David
D
Nsima
Elizabeth
E
Butrick
Suellen
S
Miller
D000328:Adult; D003906:Developing Countries; D004534:Egypt; D005260:Female; D005392:First Aid / Q000295:instrumentation / Q000379:methods; D005676:Gravity Suits; D006801:Humans; D007044:Hysterectomy; D008428:Maternal Mortality; D009549:Nigeria; D006473:Postpartum Hemorrhage / Q000401:mortality / Q000517:prevention & control*; D011203:Poverty; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000401:mortality / Q000517:prevention & control*; D011256:Pregnancy Outcome; D012769:Shock / Q000401:mortality / Q000517:prevention & control*; D014593:Uterine Inertia / Q000401:mortality / Q000517:prevention & control*