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Obstetric hemorrhage and shock management: using the low technology Non-pneumatic Anti-Shock Garment in Nigerian and Egyptian tertiary care facilities
BACKGROUND: Obstetric hemorrhage is the leading cause of maternal mortality globally. The Non-pneumatic Anti-Shock Garment (NASG) is a low-technology, first-aid compression device which, when added to standard hypovolemic shock protocols, may improve outcomes for women with hypovolemic shock seconda...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Texto |
Lenguaje: | English |
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BioMed Central
2010
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2966449/ https://www.ncbi.nlm.nih.gov/pubmed/20955600 http://dx.doi.org/10.1186/1471-2393-10-64 |
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author | Miller, Suellen Fathalla, Mohamed MF Ojengbede, Oladosu A Camlin, Carol Mourad-Youssif, Mohammed Morhason-Bello, Imran O Galadanci, Hadiza Nsima, David Butrick, Elizabeth al Hussaini, Tarek Turan, Janet Meyer, Carinne Martin, Hilarie Mohammed , Aminu I |
author_facet | Miller, Suellen Fathalla, Mohamed MF Ojengbede, Oladosu A Camlin, Carol Mourad-Youssif, Mohammed Morhason-Bello, Imran O Galadanci, Hadiza Nsima, David Butrick, Elizabeth al Hussaini, Tarek Turan, Janet Meyer, Carinne Martin, Hilarie Mohammed , Aminu I |
author_sort | Miller, Suellen |
collection | PubMed |
description | BACKGROUND: Obstetric hemorrhage is the leading cause of maternal mortality globally. The Non-pneumatic Anti-Shock Garment (NASG) is a low-technology, first-aid compression device which, when added to standard hypovolemic shock protocols, may improve outcomes for women with hypovolemic shock secondary to obstetric hemorrhage in tertiary facilities in low-resource settings. METHODS: This study employed a pre-intervention/intervention design in four facilities in Nigeria and two in Egypt. Primary outcomes were measured mean and median blood loss, severe end-organ failure morbidity (renal failure, pulmonary failure, cardiac failure, or CNS dysfunctions), mortality, and emergency hysterectomy for 1442 women with ≥750 mL blood loss and at least one sign of hemodynamic instability. Comparisons of outcomes by study phase were assessed with rank sum tests, relative risks (RR), number needed to treat for benefit (NNTb), and multiple logistic regression. RESULTS: Women in the NASG phase (n = 835) were in worse condition on study entry, 38.5% with mean arterial pressure <60 mmHg vs. 29.9% in the pre-intervention phase (p = 0.001). Despite this, negative outcomes were significantly reduced in the NASG phase: mean measured blood loss decreased from 444 mL to 240 mL (p < 0.001), maternal mortality decreased from 6.3% to 3.5% (RR 0.56, 95% CI 0.35-0.89), severe morbidities from 3.7% to 0.7% (RR 0.20, 95% CI 0.08-0.50), and emergency hysterectomy from 8.9% to 4.0% (RR 0.44, 0.23-0.86). In multiple logistic regression, there was a 55% reduced odds of mortality during the NASG phase (aOR 0.45, 0.27-0.77). The NNTb to prevent either mortality or severe morbidity was 18 (12-36). CONCLUSION: Adding the NASG to standard shock and hemorrhage management may significantly improve maternal outcomes from hypovolemic shock secondary to obstetric hemorrhage at tertiary care facilities in low-resource settings. |
format | Text |
id | pubmed-2966449 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2010 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-29664492010-10-30 Obstetric hemorrhage and shock management: using the low technology Non-pneumatic Anti-Shock Garment in Nigerian and Egyptian tertiary care facilities Miller, Suellen Fathalla, Mohamed MF Ojengbede, Oladosu A Camlin, Carol Mourad-Youssif, Mohammed Morhason-Bello, Imran O Galadanci, Hadiza Nsima, David Butrick, Elizabeth al Hussaini, Tarek Turan, Janet Meyer, Carinne Martin, Hilarie Mohammed , Aminu I BMC Pregnancy Childbirth Research Article BACKGROUND: Obstetric hemorrhage is the leading cause of maternal mortality globally. The Non-pneumatic Anti-Shock Garment (NASG) is a low-technology, first-aid compression device which, when added to standard hypovolemic shock protocols, may improve outcomes for women with hypovolemic shock secondary to obstetric hemorrhage in tertiary facilities in low-resource settings. METHODS: This study employed a pre-intervention/intervention design in four facilities in Nigeria and two in Egypt. Primary outcomes were measured mean and median blood loss, severe end-organ failure morbidity (renal failure, pulmonary failure, cardiac failure, or CNS dysfunctions), mortality, and emergency hysterectomy for 1442 women with ≥750 mL blood loss and at least one sign of hemodynamic instability. Comparisons of outcomes by study phase were assessed with rank sum tests, relative risks (RR), number needed to treat for benefit (NNTb), and multiple logistic regression. RESULTS: Women in the NASG phase (n = 835) were in worse condition on study entry, 38.5% with mean arterial pressure <60 mmHg vs. 29.9% in the pre-intervention phase (p = 0.001). Despite this, negative outcomes were significantly reduced in the NASG phase: mean measured blood loss decreased from 444 mL to 240 mL (p < 0.001), maternal mortality decreased from 6.3% to 3.5% (RR 0.56, 95% CI 0.35-0.89), severe morbidities from 3.7% to 0.7% (RR 0.20, 95% CI 0.08-0.50), and emergency hysterectomy from 8.9% to 4.0% (RR 0.44, 0.23-0.86). In multiple logistic regression, there was a 55% reduced odds of mortality during the NASG phase (aOR 0.45, 0.27-0.77). The NNTb to prevent either mortality or severe morbidity was 18 (12-36). CONCLUSION: Adding the NASG to standard shock and hemorrhage management may significantly improve maternal outcomes from hypovolemic shock secondary to obstetric hemorrhage at tertiary care facilities in low-resource settings. BioMed Central 2010-10-18 /pmc/articles/PMC2966449/ /pubmed/20955600 http://dx.doi.org/10.1186/1471-2393-10-64 Text en Copyright ©2010 Miller et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Article Miller, Suellen Fathalla, Mohamed MF Ojengbede, Oladosu A Camlin, Carol Mourad-Youssif, Mohammed Morhason-Bello, Imran O Galadanci, Hadiza Nsima, David Butrick, Elizabeth al Hussaini, Tarek Turan, Janet Meyer, Carinne Martin, Hilarie Mohammed , Aminu I Obstetric hemorrhage and shock management: using the low technology Non-pneumatic Anti-Shock Garment in Nigerian and Egyptian tertiary care facilities |
title | Obstetric hemorrhage and shock management: using the low technology Non-pneumatic Anti-Shock Garment in Nigerian and Egyptian tertiary care facilities |
title_full | Obstetric hemorrhage and shock management: using the low technology Non-pneumatic Anti-Shock Garment in Nigerian and Egyptian tertiary care facilities |
title_fullStr | Obstetric hemorrhage and shock management: using the low technology Non-pneumatic Anti-Shock Garment in Nigerian and Egyptian tertiary care facilities |
title_full_unstemmed | Obstetric hemorrhage and shock management: using the low technology Non-pneumatic Anti-Shock Garment in Nigerian and Egyptian tertiary care facilities |
title_short | Obstetric hemorrhage and shock management: using the low technology Non-pneumatic Anti-Shock Garment in Nigerian and Egyptian tertiary care facilities |
title_sort | obstetric hemorrhage and shock management: using the low technology non-pneumatic anti-shock garment in nigerian and egyptian tertiary care facilities |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2966449/ https://www.ncbi.nlm.nih.gov/pubmed/20955600 http://dx.doi.org/10.1186/1471-2393-10-64 |
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