A comparative study of the non-pneumatic anti-shock garment for the treatment of obstetric hemorrhage in Nigeria.

OBJECTIVE: To determine whether the non-pneumatic anti-shock garment (NASG) can improve maternal outcome. METHODS: Women were enrolled in a pre-intervention phase (n=83) and an intervention phase (n=86) at a referral facility in Katsina, Nigeria, from November 2006 to November 2007. Entry criteria were obstetric hemorrhage (>or=750 mL) and a clinical sign of shock (systolic blood pressure <100 mm Hg or pulse >100 beats per minute). To determine differences in demographics, condition on study entry, treatment, and outcome, t tests and chi(2) tests were used. Relative risk (RR) and 95% confidence interval (CI) were estimated for the primary outcome, mortality. RESULTS: Mean measured blood loss in the intervention phase was 73.5+/-93.9 mL, compared with 340.4+/-248.2 mL pre-intervention (P<0.001). Maternal mortality was lower in the intervention phase than in the pre-intervention phase (7 [8.1%]) vs 21 [25.3%]) (RR 0.32; 95% CI, 0.14-0.72). CONCLUSION: The NASG showed potential for reducing blood loss and maternal mortality caused by obstetric hemorrhage-related shock.

Anti-shock garment in postpartum haemorrhage.

The non-pneumatic anti-shock garment (NASG) is a first-aid device that reverses hypovolaemic shock and decreases obstetric haemorrhage. It consists of articulated neoprene segments that close tightly with Velcro, shunting blood from the lower body to the core organs, elevating blood pressure and increasing preload and cardiac output. This chapter describes the controversial history of the predecessors of NASG, pneumatic anti-shock garments (PASGs), relates case studies of PASG for obstetric haemorrhage, compares pneumatic and non-pneumatic devices and posits why the NASG is more appropriate for low-resource settings. This chapter discusses the only evidence available about NASGs for obstetric haemorrhage - two pre-post pilot trials and three case series - and describes recently initiated randomized cluster trials in Africa. Instructions and an algorithm for ASGs in haemorrhage and shock management are included. Much remains unknown about the NASG, a promising intervention for obstetric haemorrhage management.