The promise of the non-pneumatic anti-shock garment: a new tool to use against PPH: Dawn Joyce, Jennifer Clark and Suellen Miller of the Safe Motherhood Programs, Women's Global Health Imperative, University of California San Francisco, USA.

• Auteur: Joyce, Dawn

Maternal mortality and PPH

As was highlighted in last year's International Midwifery special issue on prevention of post-partum haemorrhage (PPH), every year an estimated 529,000 women die from complications of pregnancy and childbirth; 99% of these deaths occur in developing countries. (1) For every maternal mortality, there are an additional 30 maternal morbidities, (2,3) making pregnancy- and childbirth-related morbidity the second leading cause of lost years of healthy life among women of reproductive age in the developing world. (4) Obstetrical haemorrhage--of all aetiologies--is one of the five leading causes of maternal mortality. The non-pneumatic anti-shock garment (NASG) is one promising new technology currently being studied as a means for achieving the reduction of deaths from obstetric haemorrhage in low-resource settings.

How the NASG works

As illustrated in Figures 1 and 2, the NASG is a simple, relatively inexpensive, lightweight, reusable compression suit, much like the bottom half of a wet suit, comprised of five neoprene segments that close tightly with Velcro around the legs, pelvis and abdomen. (Neoprene is a tough, durable, insulating, fire-resistant synthetic fabric; Velcro is a fabric covered with either small hooks or loops, which fastens to itself without the need for buttons, studs or zips). A small foam pressure ball is incorporated into the abdominal segment to supply uterine compression. When tightly applied, the garment supplies 20-40 mmHg circumferential pressure to the body, thereby redirecting blood from the lower extremities and abdominal area back to the essential core organs: the heart, lungs and brain. Within minutes, women suffering shock from any form of obstetrical haemorrhage, including PPH, regain consciousness and their vital signs return to normal. Once a woman's bleeding has stopped, she can be safely transported from a home birth or primary health care centre to a referral facility for emergency obstetrical care. If already present at a tertiary facility, a woman can safely endure the frequently long waits for blood transfusions and additional medical or surgical procedures. (5)

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How the NASG was developed

The NASG is the most recent adaptation of an 'anti-shock garment' (ASG), a term used generically to refer to any compression device that shunts blood from the extremities to the core organs thus reversing shock. The original ASG was created in 1909 as a pressurised rubber...