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.

AuteurJoyce, 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)


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...

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