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.
Nurses and nurse-midwives in developing countries can use the non-pneumatic anti-shock garment, a first-aid tool, to stabilize women in shock from postpartum hemorrhage.
Farah Kausar is a PhD MSc Research Fellow, Safe Motherhood Program, Department of Obstetrics, Gynecology and Reproductive Sciences at University of California, San Francisco, CA.
Jessica L. Morris is a Project Specialist, Safe Motherhood Program, Department of Obstetrics, Gynecology and Reproductive Sciences at University of California, San Francisco, CA.
Mohamed Fathalla is an Associate Professor in Women's Health, Department of Obstetrics and Gynecology, Faculty of Medicine at Assuit University Women's Health Center, Assuit, Egypt.
Oladosu Ojengbede is a Professor of Obstetrics/Gynecology and Director of the Center for Population and Reproductive Health at University Teaching College, Ibadan, Nigeria.
Adetokunbo Fabamwo is an Associate Professor and Consultant Obstetrician & Gynaecologist at Lagos State University College of Medicine, Lagos, Nigeria.
Mohammed Mourad-Youssif is the Head of the Emergency Department of Obstetrics & Gynaecology at El Galaa Maternity Teaching Hospital, Cairo, Egypt.
Imran O. Morhason-Bello is on Faculty at University of Ibadan and Honorary Consultant to the University College Hospital, Ibadan, Nigeria.
Hadiza Galadanci is a Senior Lecturer and Consultant, Obstetrics/Gynecology at Aminu Kano Teaching Hospital, Kano, Nigeria.
David Nsima is an Obstetrician, Department of Obstetrics & Gynecology at Katsina General Hospital, Katsina, Nigeria
Elizabeth Butrick is the Project Director, Safe Motherhood Program, Department of Obstetrics, Gynecology and Reproductive Sciences at University of California, San Francisco, CA.
Suellen Miller is the Director of Safe Motherhood Program, Department of Obstetrics, Gynecology and Reproductive Sciences at University of California, SanFrancisco, CA. She can be reached via e-mail at firstname.lastname@example.org
The authors have no financial interest in the non-pneumatic anti-shock garment.
The authors declare no conflicts of interest.