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Keywords

Developing countries, First aid, Maternal mortality, Postpartum hemorrhage, Shock, Uterine inertia.

 

Authors

  1. Kausar, Farah PhD, MSc
  2. Morris, Jessica L MA
  3. Fathalla, Mohamed MD
  4. Ojengbede, Oladosu MBBS, FMCOG, FWACS, FICS
  5. Fabamwo, Adetokunbo MD
  6. Mourad-Youssif, Mohammed MD, MRCOG
  7. Morhason-Bello, Imran O MBBS, MSc
  8. Galadanci, Hadiza MBBS, MSc, DLSTM&H, FWACS, MRCOG, FICS
  9. Nsima, David MBBCh
  10. Butrick, Elizabeth MSW, MPH
  11. Miller, Suellen CNM, PhD

Abstract

Purpose: To discuss the role of nurses and nurse-midwives in preventing and treating postpartum hemorrhage (PPH) from uterine atony in developing countries and examine the role of a new device, the Non-pneumatic Anti-Shock Garment (NASG), in improving the outcomes for these patients.

 

Study Design and Methods: In this subanalysis of a larger preintervention phase/intervention phase study of 1,442 women with obstetric hemorrhage, postpartum women with hypovolemic shock (N = 578) from uterine atony (>=750 mL blood loss; systolic blood pressure <100 mmHg and/or pulse >100 beats per minute) were enrolled in two referral facilities in Egypt and four referral facilities in Nigeria. The study had two temporal phases: a preintervention phase and an NASG-intervention phase. Women with hemorrhage and shock in both phases were treated with the same evidence-based protocols for management of hypovolemic shock and hemorrhage, but women in the NASG-intervention phase also received the NASG. Relative risks (RRs) with 95% confidence intervals (CIs) were estimated for primary outcomes-measured blood loss, incidence of emergency hysterectomy, and mortality.

 

Results: Women in the NASG-intervention phase had significantly better outcomes, 50% lower blood loss, reduced rates of hysterectomy (8.9% vs. 4%), and mortality decreased from 8.5% to 2.3% (RR = 0.27, 95% CI: 0.12-0.60).

 

Clinical Implications: In low-resource settings nurses have few resources with which to stabilize women with severe PPH. With training nurses and nurse-midwives can stabilize hemorrhaging women with the NASG, a low-technology first-aid device that shows promise for reducing blood loss, rates of hysterectomy, and mortality.