Anti‐shock garment provides resuscitation and haemostasis for obstetric haemorrhage

Abstract

Objective To evaluate the feasibility, safety and effectiveness of the non-pneumatic anti-shock garment for resuscitation and haemostasis following obstetric haemorrhage resulting in severe shock. Design During a six-week period, the author served a locum tenens as the obstetrician consultant for the Memorial Christian Hospital, Sialkot, Pakistan. All women who suffered from severe obstetric haemorrhage were managed with the anti-shock garment as the first intervention. The data for this report were collected from hospital chart review. Setting Sialkot is a city of about three million and Memorial Christian Hospital is one of two major obstetric hospitals. There is no blood bank at Memorial Christian Hospital or elsewhere in Sialkot. The Memorial Christian Hospital laboratory is able to draw donor blood, type and cross match blood, and process it for transfusion 24 hours per day. Population During the six weeks of this study, in June and July 2001, there were 764 deliveries and 34 other admissions within a week following deliveries outside the hospital. Seven women with obstetric haemorrhage who developed severe shock were managed with the anti-shock garment. One woman, who was later found to have mitral stenosis, developed dyspnea upon placement of the anti-shock garment and therefore it was removed within 5 minutes. This report concerns the six women who were able to tolerate the anti-shock garment without untoward symptoms. Methods As soon as severe shock was recognised in the hospital, the anti-shock garment was placed.Crystalloid solutions were given intravenously over the first hour at a rate of 1500 mL per estimated litre of blood loss, then at a maintenance rate of 150 mL/hour. Vital signs every 15 to 30 minutes, hourly urine output and intermittent oxygen saturation were used to monitor patients during the use of the anti-shock garment. When sufficient blood transfusion had been given to restore the haemoglobin to >7 g/dL, the anti-shock garment was removed in segments at 15-minute intervals with documentation of vital signs before removal of each subsequent portion. Main outcome measures Restoration of mean arterial pressure of 70 mmHg and clearing of sensorium were considered as signs of effective resuscitation. Haemorrhage was considered controlled if the blood loss was less than 25 mL/hour. Morbidity included any complications noted in the medical chart. Results Restoration of blood pressure and improvement of mental status occurred within 5 minutes in two patients who were pulseless and three who were unconscious or confused. All patients had improvement of mean arterial pressure to greater than 70 mmHg within 5 minutes. Duration of anti-shock garment use ranged from 12 to 36 hours and none of the six women had significant further bleeding while the antishock garment was in place. Patients were comfortable during use of the anti-shock garment and no adverse effects were noted apart from a transient decrease in urine output. Conclusions The anti-shock garment rapidly restored vital signs in women wi...

Midwives' knowledge and utilization of non-pneumatic anti shock garment in reducing complication of postpartum haemorrhage in selected health care facilities in Bayelsa state Nigeria

“…10 The NASG's effectiveness has been proven, according to Miller et al, (2007), women treated with the NASG will improve much better than women who are not. Furthermore, women in the NASG phase experienced better outcomes.…”

Assessing the Role of the Non-Pneumatic Anti-Shock Garment in Reducing Mortality from Postpartum Hemorrhage in Nigeria

“…The utility of the NASG in low-resource referral facilities has been reported in four articles on women with obstetric hemorrhage from all etiologies, including a case series in Pakistan, a pilot pre-intervention/NASG study in Egypt (n = 364), one larger pre-intervention/NASG study in Egypt (n = 990) and one small study from one facility in Nigeria (n = 169) [10,11,12,13,14]. In this article, we examine the impact of the NASG on women suffering from PPH at four referral facilities in Nigeria.…”

Nyttig bidrag for å redusere mødredødelighet

“…Case studies and case series have, however, been published and summarized (81)(82)(83)(84)(85)(86)(87). The use of nonpneumatic antishock garments (NASGs) has been reported in a before-and-after study of 634 women with obstetric haemorrhage (43% with uterine atony) in Egypt (88).…”