Treating uterine atony with the non-pneumatic anti-shock garment in Egypt

Morris, Jessica; Meyer, Carinne; Miller, Suellen; Fathalla, Mahmoud F.; Al-Hussaini, Tarek K.; Youssif, Mohammed Mourad; Camlin, Carol S.

doi:10.12968/ajmw.2011.5.1.37

Cited by 6 publications

(6 citation statements)

References 11 publications

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“…After adjusting for pregnancy trimester, MAP < 60 mmHg, uterotonic administration, and MVA, median blood loss was 470 mL less for women in the NASG intervention phase compared with women in the pre-intervention phase. The blood-loss results in this secondary subanalysis of post-abortion hemorrhage cases are consistent with previous findings that the NASG reduces blood loss from all obstetric hemorrhage etiologies as well as when limited only to postpartum hemorrhage etiologies (Mourad-Youssif et al 2010; Morris et al 2011; Ojengbede et al 2011). Studies of the NASG in Egypt and Nigeria examining blood loss from postpartum hemorrhage found that measured blood loss decreased by 50 percent with NASG intervention; women experienced a median blood loss of 400 mL in the pre-intervention compared with 200 mL in the NASG phase (Mourad-Youssif et al 2010).…”

Section: Discussionsupporting

confidence: 90%

“…A systematic review of five studies (n = 3,563) of NASG at the tertiary-facility level found a statistically significant reduction in maternal mortality: 39 percent among all women in shock and 58 percent when the analysis was restricted only to women with the most severe shock (El Ayadi et al 2013a). Individual study results, including a subanalysis of the Egypt trial that examined only atonic hemorrhage, also found decreasing trends of similar magnitude for mortality (Morris et al 2011). Among women with postpartum hemorrhage etiologies in Nigeria, NASG was associated with a statistically significant 70 percent reduction in mortality (Ojengbede et al 2011).…”

Section: Discussionmentioning

confidence: 89%

“…Studies of the NASG in Egypt and Nigeria examining blood loss from postpartum hemorrhage found that measured blood loss decreased by 50 percent with NASG intervention; women experienced a median blood loss of 400 mL in the pre-intervention compared with 200 mL in the NASG phase (Mourad-Youssif et al 2010). Within the Egypt site alone, NASG intervention among women with obstetric hemorrhage resulting from uterine atony was associated with a significantly reduced blood loss of 409 mL among the pre-intervention group compared with 236 mL among the NASG intervention group (Morris et al 2011). A similar subanalysis of this obstetric-hemorrhage trial in Nigeria also found that mean measured blood loss was significantly lower for women in the NASG intervention phase compared with women in the pre-intervention phase (73.5 mL versus 340.4 mL) (Miller et al 2009).…”

Section: Discussionmentioning

confidence: 99%

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The Role of the Nonpneumatic Antishock Garment in Reducing Blood Loss and Mortality Associated with Post‐Abortion Hemorrhage

Manandhar

Ayadi

Butrick

et al. 2015

Studies in Family Planning

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Maternal mortality attributable to post-abortion hemorrhage is often associated with delays in reaching or receiving definitive care. The nonpneumatic antishock garment (NASG), a low-technology first-aid device, has been shown to decrease blood loss and mortality among women experiencing hypovolemic shock secondary to obstetric hemorrhage etiologies. Women experiencing post-abortion hemorrhage face longer delays in receiving definitive treatment as a result of abortion-related stigma and lack of access to quality abortion care; thus the NASG has the potential to make an even greater impact within this population. We conducted a secondary analysis of data collected in Egypt, Nigeria, Zambia, and Zimbabwe in NASG trials, limiting our analytic sample to women who experienced post-abortion hemorrhage (n = 953). Blood loss significantly decreased when the NASG was added to standard hemorrhage management during the intervention phase, and there was a large, although not statistically significant, 52 percent decrease in mortality during the NASG phase. The results indicate that adding the NASG to post-abortion care among women experiencing severe hemorrhage and hypovolemic shock would decrease blood loss and mortality.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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The Role of the Nonpneumatic Antishock Garment in Reducing Blood Loss and Mortality Associated with Post‐Abortion Hemorrhage

Manandhar

Ayadi

Butrick

et al. 2015

Studies in Family Planning

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“…This was inconsistent with a prior quasi-experimental study that found no difference between study groups in experience of abdominal pain [42], [43]. While it can be unpleasant, abdominal pain is not a safety concern.…”

Section: Discussioncontrasting

confidence: 57%

Non-Pneumatic Anti-Shock Garment (NASG), a First-Aid Device to Decrease Maternal Mortality from Obstetric Hemorrhage: A Cluster Randomized Trial

et al. 2013

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BackgroundObstetric hemorrhage is the leading cause of maternal mortality. Using a cluster randomized design, we investigated whether application of the Non-pneumatic Anti-Shock Garment (NASG) before transport to referral hospitals (RHs) from primary health care centers (PHCs) decreased adverse outcomes among women with hypovolemic shock. We hypothesized the NASG group would have a 50% reduction in adverse outcomes.Methods and FindingsWe randomly assigned 38 PHCs in Zambia and Zimbabwe to standard obstetric hemorrhage/shock protocols or the same protocols plus NASG prior to transport. All women received the NASG at the RH. The primary outcomes were maternal mortality; severe, end-organ failure maternal morbidity; and a composite mortality/morbidity outcome, which we labeled extreme adverse outcome (EAO). We also examined whether the NASG contributed to negative side effects and secondary outcomes. The sample size for statistical power was not reached; of a planned 2400 women, 880 were enrolled, 405 in the intervention group. The intervention was associated with a non-significant 46% reduced odds of mortality (OR 0.54, 95% CI 0.14–2.05, p = 0.37) and 54% reduction in composite EAO (OR 0.46, 95% CI 0.13–1.62, p = 0.22). Women with NASGs recovered from shock significantly faster (HR 1.25, 95% CI 1.02–1.52, p = 0.03). No differences were observed in secondary outcomes or negative effects. The main limitation was small sample size.ConclusionsDespite a lack of statistical significance, the 54% reduced odds of EAO and the significantly faster shock recovery suggest there might be treatment benefits from earlier application of the NASG for women experiencing delays obtaining definitive treatment for hypovolemic shock. As there are no other tools for shock management outside of referral facilities, and no safety issues found, consideration of NASGs as a temporizing measure during delays may be warranted. A pragmatic study with rigorous evaluation is suggested for further research.Trial RegistrationClinicalTrials.gov NCT00488462

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“…Before and after studies conducted in different parts of the world revealed a 55% reduction in maternal mortality, 80% reduction in blood loss, emergency hysterectomy decreased from 8.9% to 4.0%, and severe adverse outcomes lessened from 12.8% to 4.1% due to the application of NASG [ 12 – 15 ]. Evidence-based information from randomized control trials also suggested faster recovery from obstetric shock, decreased maternal mortality, severe end-organ failure, and morbidity after the utilization of NASG [ 16 – 18 ].…”

Section: Introductionmentioning

confidence: 99%

Utilization of non-pneumatic anti-shock garment and associated factors for postpartum hemorrhage management among obstetric care providers in public health facilities of southern Ethiopia, 2020

et al. 2021

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Background Delays in care have been recognized as a significant contributor to maternal mortality in low-resource settings. The non-pneumatic antishock garment is a low-cost first-aid device that can help women with obstetric haemorrhage survive these delays without long-term adverse effects. Extending professionals skills and the establishment of new technologies in basic healthcare facilities could harvest the enhancements in maternal outcomes necessary to meet the sustainable development goals. Thus, this study aims to assess utilization of non-pneumatic anti-shock garment to control complications of post-partum hemorrhage and associated factors among obstetric care providers in public health institutions of Southern Ethiopia, 2020. Methods A facility-based cross-sectional study was conducted among 412 obstetric health care providers from March 15 –June 30, 2020. A simple random sampling method was used to select the study participants. The data were collected through a pre-tested interviewer-administered questionnaire. A binary logistic regression model was used to identify determinants for the utilization of non-pneumatic antishock garment. STATA version 16 was used for data analysis. A P-value of < 0.05 was used to declare statistical significance. Results Overall, 48.5% (95%CI: 43.73, 53.48%) of the obstetric care providers had utilized Non pneumatic antishock garment for management of complications from postpartum hemorrhage. Training on Non pneumatic antishock garment (AOR = 2.92; 95% CI: 1.74, 4.92), working at hospital (AOR = 1.81; 95% CI: 1.04, 3.16), good knowledge about NASG (AOR = 1.997; 95%CI: 1.16, 3.42) and disagreed and neutral attitude on Non pneumatic antishock garment (AOR = 0.41; 95%CI: 0.24, 0.68), and (AOR = 0.39; 95% CI: 0.21, 0.73), respectively were significantly associated with obstetric care provider’s utilization of Non-pneumatic antishock garment. Conclusions In the current study, roughly half of the providers are using Non-pneumatic antishock garment for preventing complications from postpartum hemorrhage. Strategies and program initiatives should focus on strengthening in-service and continuous professional development training, thereby filling the knowledge and attitude gap among obstetric care providers. Health centers should be targeted in future programs for accessibility and utilization of non-pneumatic antishock garment.

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Treating uterine atony with the non-pneumatic anti-shock garment in Egypt

Cited by 6 publications

References 11 publications

The Role of the Nonpneumatic Antishock Garment in Reducing Blood Loss and Mortality Associated with Post‐Abortion Hemorrhage

The Role of the Nonpneumatic Antishock Garment in Reducing Blood Loss and Mortality Associated with Post‐Abortion Hemorrhage

Non-Pneumatic Anti-Shock Garment (NASG), a First-Aid Device to Decrease Maternal Mortality from Obstetric Hemorrhage: A Cluster Randomized Trial

Utilization of non-pneumatic anti-shock garment and associated factors for postpartum hemorrhage management among obstetric care providers in public health facilities of southern Ethiopia, 2020

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