158375 Management of obstetric hemorrhage not caused by uterine atony: Policy implications for safe motherhood based on pilot studies of the Non-pneumatic Anti-Shock Garment in Egypt and Nigeria

Monday, November 5, 2007: 9:10 PM

Jennifer Hackett, RN, BSN , University of California, Berkeley, Berkeley, CA
Mohamed Fathalla, MD , Department of Obstetrics and Gynecology, Assiut Teaching Hospital, Assiut, Egypt
Oladosu Ojengbede, MD , Obstetrics and Gynecology, University College Hospital, Ibadan, Nigeria
I. Oludare Morhason Bello, MD , Obstetrics and Gynecology, University College Hospital, Ibadan, Nigeria
Janet Turan, PhD, MPH , Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
Mohammed Mourad Yousiff, MD , Department of Obstetrics and Gynecology, El Galaa Maternity Hospital, Cairo, Egypt
Hilarie Martin , OB/GYN and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
Elizabeth Butrick, MPH, MSW , Obstetrics, Gynecology and Reproductive Sciences, Univeristy of California, San Francisco, San Francisco, CA
Suellen Miller, PhD, CNM , OB/GYN and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
     
Background: Millennium Development Goal 5 is to reduce maternal mortality by 75% by 2015. Recent policy on maternal mortality reduction has focused on the use of uterotonic medications for prevention and treatment of postpartum hemorrhage (PPH) due to uterine atony. However, obstetric hemorrhage includes conditions that do not respond to uterotonics, such as ectopic pregnancy, complications of abortion, and abnormal placentation (placental abruption, placenta previa, and placenta accreta). A simple, easy to apply, Velcro and neoprene compression device, the Non-pneumatic Anti-Shock Garment (NASG) has been pilot tested in Nigeria and Egypt. The NASG reverses shock by shunting blood from the lower extremities to the core and decreases bleeding in the large pelvic and abdominal vessels.

Methods: Pre/post design with pre-intervention standard management of severe obstetric hemorrhage (> 1000 mL) and shock; post-intervention same management plus application of NASG.

Findings: 11 facilities in Nigeria (188 women) and 4 facilities in Egypt (360 women); uterine atony accounted for only 40% of OH and for 20% of mortalities. Major etiologies included ectopics (12%), abortion (15%) and abnormal placentation (15%). NASG use reduced bleeding by 40% (p=.05) and mortality by 80% (ns).

Conclusions: While the NASG is still in pilot and early efficacy trials, the promising results indicate that it may be useful in managing not only PPH, but obstetric hemorrhage that is not due to uterine atony. Attention to obstetric hemorrhage deserves attention from major stakeholders and policy makers concerned with Safe Motherhood and meeting MDG 5.

Learning Objectives:
1. Describe etiologies of obstetric hemorrhage other than uterine atony and assess their role in maternal mortality due to hemorrhage. 2. Discuss mechanisms of action for the NASG. 3. Recognize potential policy implications for the introduction of the NASG into Safe Motherhood programs.

Keywords: Maternal and Child Health, International MCH

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Global Experiences with the Non-pneumatic Anti-Shock Garment: A New First Aid Device for Saving Mothers' Lives from Obstetric Hemorrhage
See more of: International Health