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Nogueira-Pileggi V, Oladapo OT, Souza JP, Cavenague de Souza HC, Pileggi-Castro C, Oyeneyin LO, Oliveira-Ciabati L, Barbosa F, Camelo JS. Unveiling the strong positive relationship: Maternal characteristics and neonatal outcomes in the Better Outcomes in Labour Difficulty (BOLD) study - a secondary analysis validating neonatal near miss classification. J Glob Health 2024; 14:04024. [PMID: 38236696 PMCID: PMC10802829 DOI: 10.7189/jogh.14.04024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
Background The near miss concept, denoting near collisions between aircraft, originated in aeronautics, but has recently been transferred to the neonatal context as a way of evaluating the quality of health services for newborns, especially in settings with reduced child mortality. However, there is yet no consensus regarding the underlying criteria. The most common indicators used to assess health care quality include mortality (maternal and neonatal) and life-threatening conditions. Using the World Health Organization (WHO) Better Outcomes in Labour Difficulty (BOLD) prospective cohort study data set, we conducted a secondary analysis to validate the near miss concept and explore the association between maternal and neonatal outcomes. Methods We studied 10 203 singleton mothers treated between December 2014 and November 2015 in nine Nigerian and four Ugandan hospitals. We validated the near miss concept by testing the diagnostic accuracy (sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and odds ratio (OR)) using death as the reference variable and calculating the maternal and neonatal case fatality rates. We performed ordinal and binomial logistic regression, with the independent variables being those that had P < 0.1 in the univariate analyses. We considered the significance level of 5%. Results We validated the neonatal near miss concept using the BOLD study data. We observed maternal and neonatal case fatality rates of 70.2% and 6.5%, with an increasing severity relationship between maternal and neonatal outcomes (P < 0.05). Ordinal logistic regression showed that gestational age <37 or >41 weeks and <8 antenatal consultations were related to a higher risk of neonatal severe outcomes, while maternal age between 30 and 34 years functioned as a protective factor against severe neonatal outcomes (SNO). Binomial logistic regression showed gestational age <37(OR = 1.46; 95% confidence interval (CI) = 1.07-1.94) or >41 weeks (OR = 2.26; 95% CI = 1.55-3.20), low educational level (OR = 1.76; 95% CI = 1.12-2.69), overweight/obesity (OR = 1.23; 95% CI = 1.02-1.47), one previous cesarean section (OR = 1.90; 95% CI = 1.36-2.61), one previous abortion (OR = 1.25; 95% CI = 1.00-1.56), and previous chronic condition (OR = 1.83; 95% CI = 1.37-2.41) were risk factors for SNO. Conclusions The neonatal near miss concept could be used as a parameter for analysis in different health systems, to ensure that measuring of neonatal severity is comparable across health care units. In this analysis, we observed a progressive association between maternal severity and the severity of the newborns' outcomes.
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Affiliation(s)
- Vicky Nogueira-Pileggi
- Department of Paediatrics – Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Olufemi T Oladapo
- UNDP, UNFPA, UNICEF, WHO, World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, Geneva, Switzerland
| | - João Paulo Souza
- Department of Social Medicine – Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Cynthia Pileggi-Castro
- Department of Paediatrics – Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Lawal O Oyeneyin
- Department of Obstetrics and Gynaecology, University of Medical Sciences Teaching Hospital, Ondo State, Nigeria
| | - Livia Oliveira-Ciabati
- UNDP, UNFPA, UNICEF, WHO, World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, Geneva, Switzerland
| | - Francisco Barbosa
- UNDP, UNFPA, UNICEF, WHO, World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, Geneva, Switzerland
| | - José Simon Camelo
- Department of Paediatrics – Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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Medina-Jaudes N, Carmone AE, Prust ML, Ngosa L, Aladesanmi O, Zulu M, Storey A, Muntanga B, Chizuni C, Mwiche A, Shakwelele H, Kamanga A. Operational demonstration and process evaluation of non-pneumatic anti-shock garment (NASG) introduction to the public health system of Northern Province, Zambia. BMC Health Serv Res 2023; 23:1321. [PMID: 38031166 PMCID: PMC10687818 DOI: 10.1186/s12913-023-10294-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND A disproportionate burden of maternal deaths occurs in low- and middle-income countries (LMICs), and obstetric hemorrhage (OH) is a leading cause of excess mortality. In Zambia, most of maternal deaths are directly caused by OH. The Non-Pneumatic Anti-Shock Garment (NASG) is a first aid tool that uses compression to the abdomen and lower body to stop and reverse hypovolemic shock secondary to OH. We describe the process and experiences introducing the NASG into the Zambia public health system to encourage the development of national policies, clinical guidelines, and implementation plans that feature the NASG. METHODS We conducted an observational study of NASG introduction to 143 public health facilities in Northern Province, Zambia, organizing observations into the five dimensions of the RE-AIM evaluation framework: reach, effectiveness, adoption, implementation, and maintenance. The NASG was introduced in August 2019, and the introduction was evaluated for 18 months. Data on healthcare worker training and mentorship, cases where NASG was used, and NASG availability and use during the study period were collected and analyzed. RESULTS The NASG was successfully introduced and integrated into the Zambia public health system, and appropriately used by healthcare workers when responding to cases of OH. Sixteen months after NASG introduction, NASGs were available and functional at 99% of study sites and 88% reported ever using a NASG. Of the 68 cases of recorded OH where a NASG was applied, 66 were confirmed as clinically appropriate, and among cases where shock index (SI) could be calculated, 59% had SI ≥ 0.9. Feedback from healthcare providers revealed that 97% thought introducing the NASG was a good decision, and 92% felt confident in their ability to apply the NASG after initial training. The RE-AIM average for this study was 0.65, suggesting a public health impact that is not equivocal, and that NASG introduction had a positive population-based effect. CONCLUSIONS A successful NASG demonstration took place over the course of 18 months in the existing health system of Northern Province, Zambia, suggesting that incorporation of NASG into the standard of care for obstetric emergency in the Zambia public sector is feasible and can be maintained without external support.
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Affiliation(s)
| | | | | | | | | | - Morrison Zulu
- Clinton Health Access Initiative, Inc, Lusaka, Zambia
| | - Andrew Storey
- Clinton Health Access Initiative, Inc, Boston, MA, USA
| | - Beauty Muntanga
- Zambia Ministry of Health, Kasama, Northern Province, Zambia
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Ali Egal J, Essa A, Osman F, Klingberg-Allvin M, Erlandsson K. Facility-based maternal deaths: Their prevalence, causes and underlying circumstances. A mixed method study from the national referral hospital of Somaliland. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 37:100862. [PMID: 37269618 DOI: 10.1016/j.srhc.2023.100862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 05/01/2023] [Accepted: 05/24/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Somaliland has one of the highest rates of maternal deaths in the world. An estimated 732 women die for every 100,000 live births. This study aims to identify the prevalence of facility-based maternal deaths, the causes and their underlying circumstances by interviewing relatives and health care providers at the main referral hospital. METHOD A hospital-based mixed method study. The prospective cross-sectional design of the WHO Maternal Near Miss tool was combined with narrative interviews with 28 relatives and 28 health care providers in direct contact with maternal deaths. The quantitative data was analysed with descriptive statistics using SPSS and the qualitative part of the study was analysed with content analysis using NVivo. RESULTS From the 6658 women included 28 women died. The highest direct cause of maternal death was severe obstetric haemorrhage (46.4%), followed by hypertensive disorders (25%) and severe sepsis (10.7%). An indirect obstetric cause of death was medical complications (17.9%). Twenty-five per cent of these cases were admitted to ICU and 89% had referred themselves to the hospital for treatment. The qualitative data identifies two categories of missed opportunities that could have prevented these maternal mortalities: poor risk awareness in the community and inadequate interprofessional collaboration at the hospital. CONCLUSION The referral system needs to be strengthened utilizing Traditional Birth Attendants as community resource supporting the community facilities. The communication skills and interprofessional collaboration of the health care providers at the hospital needs to be addressed and a national maternal death surveillance system needs to be commenced.
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Affiliation(s)
- Jama Ali Egal
- School of Health and Welfare, Dalarna University, Sweden.
| | - Amina Essa
- Department of Midwifery, University of Hargeisa, Somaliland.
| | - Fatumo Osman
- School of Health and Welfare, Dalarna University, Sweden.
| | - Marie Klingberg-Allvin
- School of Health and Welfare, Dalarna University, Sweden; Department of Women and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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Hofmeyr GJ. Novel concepts and improvisation for treating postpartum haemorrhage: a narrative review of emerging techniques. Reprod Health 2023; 20:116. [PMID: 37568196 PMCID: PMC10422815 DOI: 10.1186/s12978-023-01657-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Most treatments for postpartum haemorrhage (PPH) lack evidence of effectiveness. New innovations are ubiquitous but have not been synthesized for ready access. NARRATIVE REVIEW Pubmed 2020 to 2021 was searched on 'postpartum haemorrhage treatment', and novel reports among 755 citations were catalogued. New health care strategies included early diagnosis with a bundled first response and home-based treatment of PPH. A calibrated postpartum blood monitoring tray has been described. Oxytocin is more effective than misoprostol; addition of misoprostol to oxytocin does not improve treatment. Heat stable carbetocin has not been assessed for treatment. A thermostable microneedle oxytocin patch has been developed. Intravenous tranexamic acid reduces mortality but deaths have been reported from inadvertent intrathecal injection. New transvaginal uterine artery clamps have been described. Novel approaches to uterine balloon tamponade include improvised and purpose-designed free-flow (as opposed to fixed volume) devices and vaginal balloon tamponade. Uterine suction tamponade methods include purpose-designed and improvised devices. Restrictive fluid resuscitation, massive transfusion protocols, fibrinogen use, early cryopreciptate transfusion and point-of-care viscoelastic haemostatic assay-guided blood product transfusion have been reported. Pelvic artery embolization and endovascular balloon occlusion of the aorta and pelvic arteries are used where available. External aortic compression and direct compression of the aorta during laparotomy or aortic clamping (such as with the Paily clamp) are alternatives. Transvaginal haemostatic ligation and compression sutures, placental site sutures and a variety of novel compression sutures have been reported. These include Esike's technique, three vertical compression sutures, vertical plus horizontal compression sutures, parallel loop binding compression sutures, uterine isthmus vertical compression sutures, isthmic circumferential suture, circumferential compression sutures with intrauterine balloon, King's combined uterine suture and removable retropubic uterine compression suture. Innovative measures for placenta accreta spectrum include a lower uterine folding suture, a modified cervical inversion technique, bilateral uterine artery ligation with myometrial excision of the adherent placenta and cervico-isthmic sutures or a T-shaped lower segment repair. Technological advances include cell salvage, high frequency focussed ultrasound for placenta increta and extra-corporeal membrane oxygenation. CONCLUSIONS Knowledge of innovative methods can equip clinicians with last-resort options when faced with haemorrhage unresponsive to conventional methods.
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Affiliation(s)
- G J Hofmeyr
- Department of Obstetrics and Gynaecology, University of Botswana, Notwane Rd, Gaborone, Botswana.
- Universities of the Witwatersrand and Walter Sisulu, East London, South Africa.
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Miller S, LaLonde A. Letter to the Editor: Response to No. 431: Postpartum Hemorrhage and Hemorrhagic Shock. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:554. [PMID: 37541733 DOI: 10.1016/j.jogc.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/01/2023] [Indexed: 08/06/2023]
Affiliation(s)
- Suellen Miller
- Safe Motherhood Program, School of Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA.
| | - Andre LaLonde
- Department of Obstetrics and Gynecology, McGill University, QC
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Liu LY, Nathan L, Sheen JJ, Goffman D. Review of Current Insights and Therapeutic Approaches for the Treatment of Refractory Postpartum Hemorrhage. Int J Womens Health 2023; 15:905-926. [PMID: 37283995 PMCID: PMC10241213 DOI: 10.2147/ijwh.s366675] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/03/2023] [Indexed: 06/08/2023] Open
Abstract
Refractory postpartum hemorrhage (PPH) affects 10-20% of patients with PPH when they do not respond adequately to first-line treatments. These patients require second-line interventions, including three or more uterotonics, additional medications, transfusions, non-surgical treatments, and/or surgical intervention. Multiple studies have suggested that patients with refractory PPH have different clinical characteristics and causes of PPH when compared to patients who respond to first-line agents. This review highlights current insights into therapeutic approaches for the management of refractory PPH. Early management of refractory PPH relies on both hypovolemic resuscitation and achievement of hemostasis, with an emphasis on early blood product replacement and massive transfusion protocols. Transfusion needs can be more rapidly and accurately identified through point-of-care tests such as thromboelastography. Medical therapies for the treatment of refractory PPH involve treatment of both uterine atony as well as the underlying coagulopathy, with the use of tranexamic acid and adjunct therapies such as factor replacement. The principles guiding the management of refractory PPH include restoring normal uterine and pelvic anatomy, through the evaluation and management of retained products of conception, uterine inversion, and obstetric lacerations. Intrauterine vacuum-induced hemorrhage control devices are novel methods for the treatment of refractory PPH secondary to uterine atony, in addition to other uterine-sparing surgical procedures that are under investigation. Resuscitative endovascular balloon occlusion of the aorta can be considered for cases of critical refractory PPH, to prevent or decrease ongoing blood loss while definitive surgical interventions are performed. Finally, for patients with critical hemorrhage resulting in hemorrhagic shock, damage control resuscitation (a staged surgical approach focused on restoring normal physiologic recovery and maximizing tissue oxygenation prior to proceeding with definitive surgical management) has been shown to successfully control refractory PPH, with an overall mortality decrease for obstetric patients.
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Affiliation(s)
- Lilly Y Liu
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
| | - Lisa Nathan
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
| | - Jean-Ju Sheen
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
| | - Dena Goffman
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
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Seim AR, Alassoum Z, Souley I, Bronzan R, Mounkaila A, Ahmed LA. The effects of a peripartum strategy to prevent and treat primary postpartum haemorrhage at health facilities in Niger: a longitudinal, 72-month study. Lancet Glob Health 2023; 11:e287-e295. [PMID: 36669809 DOI: 10.1016/s2214-109x(22)00518-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 11/11/2022] [Accepted: 11/24/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Primary postpartum haemorrhage is the principal cause of birth-related maternal mortality in most settings and has remained persistently high in severely resource-constrained countries. We evaluate the impact of an intervention that aims to halve maternal mortality caused by primary postpartum haemorrhage within 2 years, nationwide in Niger. METHODS In this 72-month longitudinal study, we analysed the effects of a primary postpartum haemorrhage intervention in hospitals and health centres in Niger, using data on maternal birth outcomes assessed and recorded by the facilities' health professionals and reported once per month at the national level. Reported data were monitored, compiled, and analysed by a non-governmental organisation collaborating with the Ministry of Health. All births in all health facilities in which births occurred, nationwide, were included, with no exclusion criteria. After a preintervention survey, brief training, and supplies distribution, Niger implemented a nationwide primary postpartum haemorrhage prevention and three-step treatment strategy using misoprostol, followed if needed by an intrauterine condom tamponade, and a non-inflatable anti-shock garment, with a specific set of organisational public health tools, aiming to reduce primary postpartum haemorrhage mortality. FINDINGS Among 5 382 488 expected births, 2 254 885 (41·9%) occurred in health facilities, of which information was available on 1 380 779 births from Jan 1, 2015, to Dec 31, 2020, with reporting increasing considerably over time. Primary postpartum mortality decreased from 82 (32·16%; 95% CI 25·58-39·92) of 255 health facility maternal deaths in the 2013 preintervention survey to 146 (9·53%; 8·05-11·21) of 1532 deaths among 343 668 births in 2020. Primary postpartum haemorrhage incidence varied between 1900 (2·10%; 2·01-2·20) of 90 453 births and 4758 (1·47%; 1·43-1·52) of 322 859 births during 2015-20, an annual trend of 0·98 (95% CI 0·97-0·99; p<0·0001). INTERPRETATION Primary postpartum haemorrhage morbidity and mortality declined rapidly nationwide. Because each treatment technology that was used has shown some efficacy when used alone, a strategic combination of these treatments can reasonably attain outcomes of this magnitude. Niger's strategy warrants testing in other low-income and perhaps some middle-income settings. FUNDING The Government of Norway, the Government of Niger, the Kavli Trust (Kavlifondet), the InFiL Foundation, and individuals in Norway, the UK, and the USA. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Anders R Seim
- Health and Development International, Fjellstrand, Norway.
| | | | | | | | | | - Luai A Ahmed
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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Knowledge, Utilization, and Associated Factors of Nonpneumatic Antishock Garments for Management of Postpartum Hemorrhage among Maternity Ward Health Care Professionals in South Wollo Zone Health Facilities, Ethiopia, 2021: A Cross-Sectional Study Design. Obstet Gynecol Int 2023; 2023:8247603. [PMID: 36691431 PMCID: PMC9867589 DOI: 10.1155/2023/8247603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 11/28/2022] [Accepted: 12/17/2022] [Indexed: 01/15/2023] Open
Abstract
Background In 2017, approximately, 810 women died every day from preventable causes related to pregnancy and childbirth around the world. Obstetric hemorrhage, specifically postpartum hemorrhage, is the leading cause of preventable maternal mortality in the world. New strategies and technologies are needed to reduce the global public health epidemic of maternal mortality. However, nonpneumatic antishock garments were recently introduced and incorporated into teaching curriculums as a management modality for postpartum hemorrhage in Ethiopia. Therefore, this study assessed the knowledge, utilization and associated factors of nonpneumatic antishock garment among maternity ward healthcare professionals in the selected South Wollo zone health facilities, North West Ethiopia. Methods An institutional-based cross-sectional study design was conducted from February 1 to April 30, 2021. A consecutive sampling technique was employed to collect the data. A self-administered semistructured English version questionnaire was used to collect the data. EPI-Info and SPSS were used for data entry and analysis, respectively. Bivariable and multivariable logistic regression analyses were used to analyze the association of nonpneumatic antishock garment utilization with independent variables. Results A total of 244 maternity ward health care professionals participated. One hundred forty-six (59.8%) had a good knowledge of nonpneumatic antishock garments. About 110 (45.1%) of the participants have ever used it for the management of postpartum hemorrhage. Those having one nonpneumatic antishock garment (AOR = 2.7, 95% CI: 1.3, 5.5), two or more nonpneumatic antishock garments (AOR = 14.1, 5.7, 35.0), good knowledge (AOR = 5.2, 2.5, 10.7), and positive attitude (AOR = 2.5, 1.1, 5.7) and those who were receiving training (AOR = 2.2, 1.1, 4.4) at 95% CI were significantly associated with utilization of nonpneumatic antishock garments. Conclusion The knowledge and utilization of nonpneumatic antishock garments for the management of postpartum hemorrhage were low. Those having more nonpneumatic antishock garments, good knowledge, and a positive attitude and those who received training were found to be significantly associated with nonpneumatic antishock garment utilization. The provision of training and availability of nonpneumatic antishock garments are the key actions to be taken to increase the utilization of nonpneumatic antishock garments.
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Utilization of Nonpneumatic Antishock Garment and Associated Factors among Obstetric Care Providers in Public Hospitals of Sidama Region, Hawassa, Ethiopia, 2022. J Pregnancy 2023; 2023:6129903. [PMID: 36686338 PMCID: PMC9851775 DOI: 10.1155/2023/6129903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 11/29/2022] [Accepted: 01/03/2023] [Indexed: 01/15/2023] Open
Abstract
Background Nonpneumatic antishock garment is one of the newly emerging technology advances that reduce blood loss which is caused by obstetric hemorrhage and help women survive during delays to get definitive care. Over 80% of maternal mortality due to hemorrhagic shock may have been prevented if a nonpneumatic antishock garment had been utilized by an obstetric care provider. However, to the current knowledge, the utilization of nonpneumatic antishock garments is low and even no single study was conducted in the study area. Hence, we found that it is necessary to assess the magnitude and factors affecting the utilization of antishock garments among obstetric care providers in public hospitals of the Sidama region, Ethiopia, 2022. Methods A facility-based cross-sectional study design was employed among 403 obstetric care providers from June 15 to July 15, 2022. A two-stage sampling technique was applied; the data was collected by 5 trained BSc midwives using pretested and structured self-administered questionnaires. Data was entered into EpiData Manager version 4.6 and exported to Statistical Package for Social Sciences (SPSS) version 26 software. Bivariate and multivariable logistic regression analyses were used. Results A total of 394 (97.8%) health professionals participated in this study. Overall, 30.71% (95% CI: 26.4%, 35%) of the obstetric care providers had utilized nonpneumatic antishock garments for the management of postpartum hemorrhage. Training on the antishock garment (AOR = 4.183, 95% CI: 2.167, 8.075, p < 0.00), tertiary hospital (AOR = 0.355, 95% CI: 0.132, 0.952, p < 0.04), having protocol in the facility (AOR = 2.758, 95% CI: 1.269, 5.996), availability of NASG in the facility (AOR = 4.6, 95% CI: 1.603, 13.24), good knowledge (AOR = 2.506, 95% CI: 1.26, 4.984), and positive attitude (AOR = 2.381, 95% CI: 1.189, 4.766) were significantly associated factors. Conclusion and Recommendation. We found that less than one-third of the study participants have used the antishock garment in the management of postpartum hemorrhage in the current study. In addition to enhancing in-service and ongoing professional development training, it is preferable to insure the availability and accessibility of antishock in the facilities in order to close the knowledge and attitude gap among obstetric care providers.
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Taye BT, Silesh Zerihun M, Moltot Kitaw T, Amogne FK, Kindie Behulu G, Lemma Demisse T, Chekole MS, Fitie GW, Worku SA, Kibiret DM, Ferede AA, Bejtual K, Desalegn T, Tiguh AE, Mihret MS, Kebede AA. Utilization of non-pneumatic anti-shock garment for the management of obstetric hemorrhage among healthcare providers in north Shewa zone, Ethiopia. Front Public Health 2023; 11:1052885. [PMID: 37181723 PMCID: PMC10173860 DOI: 10.3389/fpubh.2023.1052885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
Background Global maternal deaths have either increased or stagnated tragically. Obstetric hemorrhage (OH) remains the major cause of maternal deaths. Non-Pneumatic Anti-Shock Garment (NASG) has several positive results in the management of obstetric hemorrhage in resource-limited settings where getting definitive treatments are difficult and limited. Therefore, this study aimed to assess the proportion and factors associated with the utilization of NASG for the management of obstetric hemorrhage among healthcare providers in the North Shewa zone, Ethiopia. Methods A cross-sectional study was conducted at health facilities of the north Shewa zone, Ethiopia from June 10th-30th/2021. A simple random sampling (SRS) technique was employed among 360 healthcare providers. Data were collected using a pretested self-administered questionnaire. EpiData version 4.6 and SPSS 25 were used for data entry and analysis, respectively. Binary logistic regression analyses were undertaken to identify associated factors with the outcome variable. The level of significance was decided at a value of p of <0.05. Results The utilization of NASG for the management of obstetric hemorrhage among healthcare providers was 39% (95%CI: 34-45). Healthcare providers who received training on NASG (AOR = 3.3; 95%CI: 1.46-7.48), availability of NASG in the health facility (AOR = 9.17; 95%CI: 5.10-16.46), diploma (AOR = 2.63; 95%CI: 1.39-3.68), bachelor degree (AOR = 7.89; 95%CI: 3.1-16.29) and those healthcare providers who have a positive attitude toward utilization of NASG (AOR = 1.63; 95%CI: 1.14-2.82) were variables positively associated with the utilization of NASG. Conclusion In this study, almost two-fifths of healthcare providers used NASG for the management of obstetrics hemorrhage. Arranging educational opportunities and continuous professional development training for healthcare providers, providing in-service and refresher training, and making it available at health facilities may help healthcare providers to effectively use the device, thereby reducing maternal morbidity and mortality.
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Affiliation(s)
- Birhan Tsegaw Taye
- School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Birhan, Ethiopia
- *Correspondence: Birhan Tsegaw Taye,
| | - Mulualem Silesh Zerihun
- School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Birhan, Ethiopia
| | - Tebabere Moltot Kitaw
- School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Birhan, Ethiopia
| | - Fetene Kasahun Amogne
- School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Birhan, Ethiopia
| | - Geremew Kindie Behulu
- School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Birhan, Ethiopia
| | - Tesfanesh Lemma Demisse
- School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Birhan, Ethiopia
| | - Moges Sisay Chekole
- School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Birhan, Ethiopia
| | - Girma Wogie Fitie
- School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Birhan, Ethiopia
| | - Solomon Adanew Worku
- School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Birhan, Ethiopia
| | - Desta Mekete Kibiret
- Department of Midwifery, Faculty of Public Health and Medical Science, Mettu University, Metu, Ethiopia
| | - Addisu Andualem Ferede
- Department of Midwifery, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Kalkidan Bejtual
- Department of Midwifery, Bule Hora University, Bule Hora, Ethiopia
| | | | - Agumas Eskezia Tiguh
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Muhabaw Shumye Mihret
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Azmeraw Ambachew Kebede
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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11
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Marcus JK, Fawcus S. Clinical algorithms for management of third stage abnormalities. BJOG 2022. [PMID: 35411672 DOI: 10.1111/1471-0528.16729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 11/28/2022]
Abstract
AIMS To develop algorithms for identifying, managing and monitoring postpartum haemorrhage (PPH) and other third stage of labour abnormalities after vaginal delivery. POPULATION Women with low-risk singleton term pregnancies who have had a vaginal delivery. SETTING Hospital settings with a particular focus on healthcare facilities in low- and middle-income countries (LMICs). SEARCH STRATEGY Searches for international and national guidance documents, research databases (Cochrane, Medline and CINAHL) and published systematic reviews. Searches were limited to work published in English between 1 January 2008 and 31 December 2018. CASE SCENARIOS Four interlinked case scenarios were identified for algorithm development: (1) an approach to PPH after vaginal delivery, (2) uterine atony, (3) genital tract trauma and (4) retained placenta/placental products. CONCLUSIONS The development of clear approaches to the assessment, resuscitation, treatment and monitoring of the four case scenarios are presented as algorithms, based on available evidence. They need to be field tested and evaluated for effectiveness, and may be adapted for electronic decision support tools using artificial intelligence in different settings. Further research is needed around multimodal sequential packages of care for PPH, conservative surgical measures, resuscitation in LMICs, and how a respectful maternity care focus can be incorporated into the algorithms. TWEETABLE ABSTRACT Algorithm development for standardised approaches to managing PPH in low-resource settings.
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Affiliation(s)
- J K Marcus
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - S Fawcus
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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12
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Escobar MF, Nassar AH, Theron G, Barnea ER, Nicholson W, Ramasauskaite D, Lloyd I, Chandraharan E, Miller S, Burke T, Ossanan G, Andres Carvajal J, Ramos I, Hincapie MA, Loaiza S, Nasner D. FIGO recommendations on the management of postpartum hemorrhage 2022. Int J Gynaecol Obstet 2022; 157 Suppl 1:3-50. [PMID: 35297039 PMCID: PMC9313855 DOI: 10.1002/ijgo.14116] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Maria Fernanda Escobar
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Anwar H Nassar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Gerhard Theron
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.,Tygerberg Hospital, Cape Town, South Africa
| | - Eythan R Barnea
- Society for Investigation or Early Pregnancy (SIEP), New York, New York, USA
| | - Wanda Nicholson
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Diana Ramasauskaite
- Center of Obstetrics and Gynecology, Vilnius University Medical Faculty, Vilnius, Lithuania
| | - Isabel Lloyd
- Department of Obstetrics and Gynecology, Universidad de Panamá, Panama City, Panamá.,Hospital Santo Tomas, Panama City, Panamá
| | - Edwin Chandraharan
- Department of Obstetrics and Gynecology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Suellen Miller
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Thomas Burke
- Division of Global Health and Human Rights, Massachusetts General Hospital, Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Harvard T.H. Chan School of Public Health, Boston, USA
| | - Gabriel Ossanan
- Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Javier Andres Carvajal
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Isabella Ramos
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Maria Antonia Hincapie
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Sara Loaiza
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Daniela Nasner
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | -
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia
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13
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Castiblanco Montañez RA, Coronado Veloza CM, Morales Ballesteros LV, Polo González TV, Saavedra Leyva AJ. Hemorragia postparto: intervenciones y tratamiento del profesional de enfermería para prevenir shock hipovolémico. REVISTA CUIDARTE 2022. [DOI: 10.15649/cuidarte.2075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introducción: En Colombia la hemorragia postparto es la segunda causa de mortalidad en mujeres gestantes de 24 a 34 años con 6,9 casos por cada 1000 nacidos vivos. Después del parto se prevé que el 8.2% de las mujeres latinoamericanas presentarán hemorragia postparto. Objetivo: Describir el cuidado de enfermería a mujeres que presentan hemorragia postparto para disminuir el riesgo de shock hipovolémico, a través de una revisión integrativa de la literatura. Metodología: Revisión integrativa de la literatura siguiendo la propuesta por Sasso, de Campos y Galvão, se realizó una búsqueda en ClinicalKey, LILACS, CINAHL, Epistemonikos, Cochrane Library, PubMed, Scielo y Google Scholar; se incluyeron artículos publicados en los últimos cinco años, en español, inglés y portugués, se clasificaron por nivel de evidencia y grado de recomendación. Esta investigación es de bajo riesgo por ser de tipo documental. Resultados: Se recopilaron 41 artículos definitivos. La información se organizó en: cuadro clínico, cuidados de enfermería y dificultades en la atención gineco-obstétrica. Discusión: El profesional de enfermería debe identificar barreras en la atención evaluando la capacidad resolutiva de las instituciones y analizando los casos de muerte materna. Se recomienda el uso de misoprostol con oxitocina o únicamente de carbetocina y la combinación de ergometrina con oxitocina según el volumen de sangrado. Conclusión: Es pertinente realizar un examen físico para reconocer signos de inestabilidad hemodinámica, y de shock hipovolémico. Además, los diagnósticos e intervenciones de enfermería se enfocan en brindar cuidados de calidad, para evitar complicaciones como la muerte.
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14
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Magwali TL, Svisva A, Bowers T, Chiyaka F, Conway JD, Madzima B, Mambo V, Mangwiro A, Carmone AE. Applying the RE-AIM framework in a process evaluation of the introduction of the Non-Pneumatic Anti-Shock Garment in a rural district of Zimbabwe. PLoS One 2021; 16:e0251908. [PMID: 34015006 PMCID: PMC8136624 DOI: 10.1371/journal.pone.0251908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 05/05/2021] [Indexed: 11/19/2022] Open
Abstract
The Non-Pneumatic Anti-Shock Garment (NASG) is a first aid tool that can halt and reverse hypovolemic shock secondary to obstetric hemorrhage. The World Health Organization recommended the NASG for use as a temporizing measure in 2012, but uptake of the recommendation has been slow, partially because operational experience is limited. The study is a process evaluation of the introduction of NASG in a public sector health facility network in rural Zimbabwe utilizing an adapted RE-AIM, categorizing observations into the domains of: reach, effectiveness, adoption, implementation and maintenance. The location of the study was Hurungwe district, where staff members of 34 health facilities at primary (31), secondary (2) and tertiary (1) levels of care participated. We found that all facilities became skilled in using the NASG, and that the NASG was used in 10 of 11 instances of severe hemorrhage. In the cases of hypovolemic shock where the NASG was used, there were no maternal deaths and no extreme adverse outcomes related to obstetric hemorrhage in the study period. Among the 10 NASG uses, the garment was used correctly in each case. Fidelity to processes was high, especially in regard to training and cascading skills, but revisions of the NASG rotation and replacement operating procedures were required to keep clean garments stocked. Clinical documentation was also a key challenge. NASG introduction dovetailed very well with pre-existing systems for obstetric emergency response, and improved clinical outcomes. Scale-up of the NASG in the Zimbabwean public health system can be undertaken with careful attention to mentorship, drills, documentation and logistics.
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Affiliation(s)
- Thulani Leslie Magwali
- Department of Obstetrics and Gynaecology, University of Zimbabwe, Harare, Zimbabwe
- * E-mail: (AEC); (TLM)
| | | | | | | | | | - Bernard Madzima
- Maternal Health Program, Zimbabwe Ministry of Health, Harare, Zimbabwe
| | - Violet Mambo
- Department of Obstetrics and Gynaecology, University of Zimbabwe, Harare, Zimbabwe
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15
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Crassard I, Berthet K, Lavallée P, Houot M, Payen D, Baron JC, Amarenco P, Lukaszewicz AC. Temporary application of lower body positive pressure improves intracranial velocities in symptomatic acute carotid occlusion or tight stenosis: A pilot study. Int J Stroke 2021; 17:308-314. [PMID: 33759644 DOI: 10.1177/17474930211008003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Patients with isolated cervical carotid artery occlusion not eligible to recanalization therapies but with compromised intracranial hemodynamics may be at risk of further clinical events. Apart from lying flat until spontaneous recanalization or adjustment of the collateral circulation hopefully occurs, no specific treatment is currently implemented. Improving collateral flow is an attractive option in this setting. Lower body positive pressure (LBPP) is known to result in rapid venous blood shift from the lower to the upper body part, in turn improving cardiac preload and output, and is routinely used in acute hemorrhagic shock. We report here cerebral blood flow velocities measured during LBPP in this patient population. METHODS This is a retrospective analysis of the clinical, physiological, and transcranial Doppler monitoring data collected during and 15 min after LBPP in 21 consecutive patients (10 females, median age: 54 years) with recently symptomatic isolated carotid occlusion/tight stenosis (unilateral in 18) mostly due to atherosclerosis or dissection. LBPP was applied for 90 min at a median 5 days after symptom onset. RESULTS At baseline, middle-cerebral artery velocities were markedly lower on the symptomatic, as compared to asymptomatic, side. LBPP significantly improved blood flow velocities in both the symptomatic and asymptomatic middle-cerebral artery as well as the basilar artery, which persisted 15 min after discontinuing the procedure. LBPP also resulted in mild but significant increases in mean arterial blood pressure. CONCLUSIONS LBPP improved intracranial hemodynamics downstream recently symptomatic carotid occlusion/tight stenosis as well as in the contralateral and posterior circulations, which persisted after LBPP deflation. Randomized trials should determine if this easy-to-use, noninvasive, nonpharmacologic approach has long-lasting benefits on the intracranial circulation and improves functional outcome.
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Affiliation(s)
| | - Karine Berthet
- Neurology Department, Hôpital Lariboisière, Paris, France.,Neuraltide, iPEPS, Brain and Spine Institute, Paris, France
| | - Philippa Lavallée
- Department of Neurology and Stroke Center, Hôpital Bichat, Paris, France
| | - Marion Houot
- Centre of Excellence for Neurodegenerative Disease (CoEN), Hôpital Salpêtrière, Paris, France.,Institute of Memory and Alzheimer's disease (IM2A), Department of Neurology, Hôpital Salpêtrière, AP-HP, Paris, France.,Clinical Investigation Centre, Institut du Cerveau et de la Moelle épinière (ICM), Hôpital Salpêtrière, Paris, France
| | - Didier Payen
- Université de Paris, UFR de Médecine Sorbonne, Paris, France
| | - Jean-Claude Baron
- Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), 27102INSERM U1266, Paris, France.,Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
| | - Pierre Amarenco
- Department of Neurology and Stroke Center, Hôpital Bichat, Paris, France
| | - Anne-Claire Lukaszewicz
- Department of Anesthesiology and Intensive Care, Hôpital Edouard Herriot, Hospices Civils de Lyon, France.,EA 7426 PI3, Université de Lyon-BioMerieux, Lyon, France
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16
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Weeks AD, Fawcus S. Management of the third stage of labour: (for the Optimal Intrapartum Care series edited by Mercedes Bonet, Femi Oladapo and Metin Gülmezoglu). Best Pract Res Clin Obstet Gynaecol 2020; 67:65-79. [PMID: 32402601 DOI: 10.1016/j.bpobgyn.2020.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/18/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Abstract
The physiology of the third stage of labour is described. Active management reduces the risk of postpartum haemorrhage (PPH), due to the use of a uterotonic agent. Intramuscular Oxytocin 10 IU has the highest efficacy and lowest side effect profile, although ergometrine, carbetocin and misoprostol are also effective. The appropriate uterotonic in different settings such as home birth by unskilled attendants and at caesarean section is discussed. For the latter, there is less consensus on the optimal dose/route of oxytocin, this topic remaining on the research agenda. Delayed cord clamping enables transfusion of blood to the neonate and is recommended rather than early clamping. Controlled cord traction should only be performed by skilled birth attendants and confers minimal advantage in preventing retained placenta. The importance of early recognition of PPH, and preparedness, is emphasised. An approach to medical and surgical management of PPH is presented.
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Affiliation(s)
- Andrew D Weeks
- Department of Women's and Children's Health, Liverpool Women's Hospital and University of Liverpool for Liverpool Health Partners, Sanyu Research Unit, Liverpool Women's Hospital, Crown Street, Liverpool, L8 7SS, UK.
| | - Susan Fawcus
- Department of Obstetrics and Gynaecology, University of Cape Town, H floor Old Main Building, Grooteschuur Hospital, Anzio Road, Observatory, Cape Town 7925, South Africa.
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17
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Bekele G, Terefe G, Sinaga M, Belina S. Utilization of non-pneumatic anti-shock garment and associated factors for postpartum hemorrhage management among health care professionals' in public hospitals of Jimma zone, south-West Ethiopia, 2019. Reprod Health 2020; 17:37. [PMID: 32183846 PMCID: PMC7076916 DOI: 10.1186/s12978-020-0891-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 03/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non- pneumatic anti-shock garment is a unique, life -saving first -aid device made of neoprene and velcro, which is used for treatment of women with postpartum hemorrhage. Maternal mortality in the world still very high and postpartum hemorrhage is the leading cause of maternal mortality worldwide. OBJECTIVE This study was aimed to assess the utilization of non-pneumatic anti-shock garment and associated factors for postpartum hemorrhage management. METHODS Facility based cross-sectional studies design both quantitative and qualitative data collection methods were employed among 210 health care professionals and 10 key informants respectively. Bivariable and multivariable logistic regression was done to identify factors associated with non-pneumatic anti-shock garment utilization. Qualitative data was transcribed, translated and triangulated with quantitative findings. RESULTS Seventy six (36.2%) of the respondents used non-pneumatic anti-shock garment in their hospitals for management of post-partum hemorrhage. Having good knowledge [(AOR = 3.96, 95% CI: (1.67, 9.407)], having positive attitude [(AOR = 3.54, 95% CI: (1.37, 9.13)], attending training [AOR = 13.156, 95% CI: (4.81, 36.00], having two and above non-pneumatic anti-shock garment at their hospitals [AOR = 8.7, 95% CI: (2.89, 26.20)] were significantly associated with utilization of non-pneumatic anti-shock garment. … "I didn't use non-pneumatic anti-shock garment for the management of postpartum hemorrhage complication before because I have no training and experience how to use it." CONCLUSION The utilization of non-pneumatic anti-shock garment for the management of postpartum hemorrhage was low. Having positive attitude, having good knowledge and training on non-pneumatic anti-shock garment were statically associated with its use. The health care professionals that involved in the maternity service should be trained on how to use this important garment in the management of postpartum hemorrhage.
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Affiliation(s)
- Gadisa Bekele
- School of Nursing and Midwifery, Faculty of health Sciences, Institute of health, Jimma University, P.O.BOX:378, Jimma, Ethiopia.
| | - Gemechu Terefe
- School of Nursing and Midwifery, Faculty of health Sciences, Institute of health, Jimma University, P.O.BOX:378, Jimma, Ethiopia
| | - Makeda Sinaga
- School of Nursing and Midwifery, Faculty of health Sciences, Institute of health, Jimma University, P.O.BOX:378, Jimma, Ethiopia
| | - Sena Belina
- School of Nursing and Midwifery, Faculty of health Sciences, Institute of health, Jimma University, P.O.BOX:378, Jimma, Ethiopia
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18
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Assessing and managing hypovolemic shock in puerperal women. Best Pract Res Clin Obstet Gynaecol 2019; 61:89-105. [DOI: 10.1016/j.bpobgyn.2019.05.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/20/2019] [Accepted: 05/20/2019] [Indexed: 12/17/2022]
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19
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Escobar MF, Suso JP, Hincapié MA, Echavarría MP, Fernández P, Carvajal J. Experience of combined use of a Bakri uterine balloon and a non‐pneumatic anti‐shock garment in a university hospital in Colombia. Int J Gynaecol Obstet 2019; 146:244-249. [DOI: 10.1002/ijgo.12872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 02/28/2019] [Accepted: 05/24/2019] [Indexed: 11/09/2022]
Affiliation(s)
- María F. Escobar
- High Complexity Obstetric UnitDepartment of Gynecology & ObstetricsFundación Valle del Lili Cali Colombia
- Postgraduate DepartmentFaculty of Health SciencesIcesi University Cali Colombia
| | - Juan P. Suso
- Postgraduate DepartmentFaculty of Health SciencesIcesi University Cali Colombia
| | - María A. Hincapié
- Postgraduate DepartmentFaculty of Health SciencesIcesi University Cali Colombia
| | - María P. Echavarría
- High Complexity Obstetric UnitDepartment of Gynecology & ObstetricsFundación Valle del Lili Cali Colombia
- Postgraduate DepartmentFaculty of Health SciencesIcesi University Cali Colombia
| | - Paula Fernández
- Centro de Investigaciones ClínicasFundación Valle del Lili Cali Colombia
| | - Javier Carvajal
- High Complexity Obstetric UnitDepartment of Gynecology & ObstetricsFundación Valle del Lili Cali Colombia
- Postgraduate DepartmentFaculty of Health SciencesIcesi University Cali Colombia
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20
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Fawcus S. Practical approaches to managing postpartum haemorrhage with limited resources. Best Pract Res Clin Obstet Gynaecol 2019; 61:143-155. [PMID: 31103529 DOI: 10.1016/j.bpobgyn.2019.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/20/2019] [Accepted: 03/31/2019] [Indexed: 10/26/2022]
Abstract
Mortality from postpartum haemorrhage (PPH) is higher in low resource settings due to increased incidence, higher case fatality rates and poor general health of the population. The challenges of managing PPH with limited resources are presented. Feasible interventions for preventing and treating PPH for home births are described. Given that maternity care is organised around levels of care in low resource settings, guidance is provided for what measures can be performed to manage PPH at different levels of care (clinic, community health centre, district hospital, regional and central hospital); and by which cadre (midwife, clinical officer, general doctor, specialist). Effective management of PPH requires on-going training and emergency drills. Reducing mortality from PPH is not possible without available urgent transport from home to facility and between levels of care. In addition, the essential building blocks of the health system must be functional to enable effective management of PPH.
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Affiliation(s)
- Susan Fawcus
- Department of Obstetrics and Gynaecology, University of Cape Town, H floor Old Main building, Grooteschuur Hospital, Anzio road, Observatory, Cape Town, 7925, South Africa.
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21
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Vogel JP, Williams M, Gallos I, Althabe F, Oladapo OT. WHO recommendations on uterotonics for postpartum haemorrhage prevention: what works, and which one? BMJ Glob Health 2019; 4:e001466. [PMID: 31139461 PMCID: PMC6509591 DOI: 10.1136/bmjgh-2019-001466] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/10/2019] [Accepted: 03/16/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Joshua P Vogel
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
- Maternal and Child Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Myfanwy Williams
- Cochrane Pregnancy and Childbirth, University of Liverpool, Liverpool, United Kingdom
| | - Ioannis Gallos
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham Women's Hospital Foundation Trust, Birmingham, United Kingdom
| | - Fernando Althabe
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Olufemi T Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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22
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Muñoz M, Stensballe J, Ducloy-Bouthors AS, Bonnet MP, De Robertis E, Fornet I, Goffinet F, Hofer S, Holzgreve W, Manrique S, Nizard J, Christory F, Samama CM, Hardy JF. Patient blood management in obstetrics: prevention and treatment of postpartum haemorrhage. A NATA consensus statement. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2019; 17:112-136. [PMID: 30865585 PMCID: PMC6476742 DOI: 10.2450/2019.0245-18] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 12/14/2018] [Indexed: 04/20/2023]
Abstract
Patient blood management (PBM) is the timely application of evidence-informed medical and surgical concepts designed to maintain haemoglobin concentration, optimise haemostasis, and minimise blood loss in an effort to improve patient outcomes. The aim of this consensus statement is to provide recommendations on the prevention and treatment of postpartum haemorrhage as part of PBM in obstetrics. A multidisciplinary panel of physicians with expertise in obstetrics, anaesthesia, haematology, and transfusion medicine was convened by the Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis (NATA) in collaboration with the International Federation of Gynaecology and Obstetrics (FIGO), the European Board and College of Obstetrics and Gynaecology (EBCOG), and the European Society of Anaesthesiology (ESA). Members of the task force assessed the quantity, quality and consistency of the published evidence, and formulated recommendations using the system developed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group. The recommendations in this consensus statement are intended for use by clinical practitioners managing perinatal care of women in all settings, and by policy-makers in charge of decision making for the update of clinical practice in health care establishments.
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Affiliation(s)
- Manuel Muñoz
- Perioperative Transfusion Medicine, Department of Surgical Specialities, Biochemistry and Inmunology, University of Málaga, Málaga, Spain
- Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis, Paris, France (NATA)
| | - Jakob Stensballe
- Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis, Paris, France (NATA)
- Section for Transfusion Medicine, Capital Region Blood Bank, and Department of Anaesthesiology, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Marie-Pierre Bonnet
- Department of Anaesthesia and Intensive Care Medicine, Cochin University Hospital, Paris, France
| | - Edoardo De Robertis
- Department of Neurosciences, Reproductive and Odontostomatologic Sciences, University Federico II, Naples, Italy
- European Society of Anaesthesiology, Brussels, Belgium (ESA)
| | - Ino Fornet
- Deparment of Anesthesiology, University Hospital Puerta de Hierro, Madrid, Spain
| | - François Goffinet
- Department of Obstetrics and Gynecology, Port-Royal Maternity, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Stefan Hofer
- Clinic for Anesthesiology, Intensive Care and Emergency Medicine I, Westpfalz Hospital, Kaiserslautern, Germany
| | - Wolfgang Holzgreve
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
- International Federation of Gynaecology and Obstetrics, London, UK (FIGO)
| | - Susana Manrique
- Deparment of Anesthesiology, University Hospital Vall d’Hebron, Barcelona, Spain
| | - Jacky Nizard
- Department of Obstetrics and Gynecology, Groupe Hospitalier Pitié Salpêtrière, Université Pierre et Marie Curie-Paris 6, Paris, France
- European Board and College of Obstetrics and Gynaecology, Brussels, Belgium (EBCOG)
| | - François Christory
- Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis, Paris, France (NATA)
| | - Charles-Marc Samama
- Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis, Paris, France (NATA)
- Department of Anaesthesia and Intensive Care Medicine, Cochin University Hospital, Paris, France
| | - Jean-François Hardy
- Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis, Paris, France (NATA)
- Department of Anaesthesiology, Université de Montréal, Montreal, QC, Canada
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Escobar MF, Fernández Pérez PA, Carvajal JA, Burgos JM, Messa A, Echavarria MP, Nieto A, Montes D, Miller S, Hurtado DF. Impact of nonpneumatic antishock garment in the management of patients with hypoperfusion due to massive postpartum hemorrhage. J Matern Fetal Neonatal Med 2019; 33:3086-3090. [PMID: 30632844 DOI: 10.1080/14767058.2019.1568982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: The objective of this article was to compare hemodynamic and perfusion parameters as well as the clinical outcomes in critically ill patients with postpartum hemorrhage (PPH) who received treatment with a nonpneumatic antishock garment (NASG) as part of an intervention package, with a group of patients in similar conditions who did not receive an NASG.Methods: This observational study analyzed a historic cohort of 154 patients with PPH, secondary hypovolemic shock and signs of hypoperfusion who were admitted to this institution from 2012 to 2015. Group 1 (n= 77) was managed with NASG and Group 2 (n = 77) received interventions other than NASG. Hypoperfusion markers and maternal outcomes were compared in both groups.Results: Of 154 patients included in the analysis, 36.4% required a total abdominal hysterectomy (TAH) to achieve hemorrhage control, 98.2% of whom belonged to Group 2 and 1.8% to Group 1 (p = .001). The use of blood products was more common in Group 2 (p < .001), as was the administration of vasoactive agents. The mean number of days of hospitalization at the Obstetric High Dependency Unit (OHDU) was significantly lower in Group 1 and reached a statistically significant p value. Only two cases of maternal death occurred in Group 2.Discussion: The use of NASG in the management of PPH is a cost-effective strategy for patients with severe shock and signs of hypoperfusion and is optimal in a limited-resource scenario. In this study, the use of NASG was related to better outcomes in a statistically significant manner with better results regarding maternal outcomes such as uterine preservation and decreased transfusion requirements and hospital days.Conclusions: NASG, associated with the use of uterotonic agents and other strategies for PPH control, is a safe tool that helps reduce morbimortality in critically ill patients with PPH.
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Affiliation(s)
- Maria Fernanda Escobar
- Department of Gynecology and Obstetrics, Fundación Clínica Valle Del Lili, Cali, Colombia.,Departament of Health Science, Faculty of Medicine, ICESI University, Cali, Colombia
| | | | - Javier Andrés Carvajal
- Department of Gynecology and Obstetrics, Fundación Clínica Valle Del Lili, Cali, Colombia
| | - Juan Manuel Burgos
- Department of Gynecology and Obstetrics, Fundación Clínica Valle Del Lili, Cali, Colombia
| | - Adriana Messa
- Department of Gynecology and Obstetrics, Fundación Clínica Valle Del Lili, Cali, Colombia
| | - Maria Paula Echavarria
- Department of Gynecology and Obstetrics, Fundación Clínica Valle Del Lili, Cali, Colombia
| | - Albaro Nieto
- Department of Gynecology and Obstetrics, Fundación Clínica Valle Del Lili, Cali, Colombia
| | - Daniela Montes
- Departament of Health Science, Faculty of Medicine, ICESI University, Cali, Colombia
| | - Suellen Miller
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Bixby Center for Global Reproductive Health and Policy, School of Medicine, University of California, San Francisco, CA, USA
| | - David Felipe Hurtado
- Departament of Health Science, Faculty of Medicine, ICESI University, Cali, Colombia
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Mbaruku G, Therrien MS, Tillya R, Mbuyita S, Mtema Z, Kinyonge I, Godfrey R, Temu S, Miller S. Implementation project of the non-pneumatic anti-shock garment and m-communication to enhance maternal health care in rural Tanzania. Reprod Health 2018; 15:177. [PMID: 30340602 PMCID: PMC6194579 DOI: 10.1186/s12978-018-0613-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 09/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obstetric hemorrhage (OH) remains one of the leading causes of maternal mortality, particularly in rural Africa. Tanzania has a high maternal mortality ratio, and approximately 80% of the population accesses health care lower level facilities, unable to provide Comprehensive Emergency Obstetric Care (CEmOC). The non-pneumatic anti-shock garment (NASG) has been demonstrated to reduce mortality as it buys time for women in shock to be transported to or to overcome delays at referral facilities. METHODS This report describes one component of an ongoing maternal health improvement project, Empower, implemented in 280 facilities in four regions in rural Tanzania. The NASG along with a Closed User Group (CUG) mobile phone network were implemented within the overall EmOC project. Simulation trainings, repeated trainings, and close hands-on supportive supervision via site visits and via the CUG network were the training/learning methods. Data collection was conducted via the CUG network, with a limited data collection form, which also included free text options for project improvement. One-to-one interviews were also conducted. Outcome Indicators included appropriate use of NASG for women with hypovolemic shock We also compared baseline case fatality rates (CFR) from OH with endline CFRs. Data were analyzed using cohort study Risk Ratio (RR). Qualitative data analysis was conducted by content analysis. RESULTS Of the 1713 women with OH, 419 (24.5%) met project hypovolemic shock criteria, the NASG was applied to 70.8% (n = 297), indicating high acceptability and utilization. CFR at baseline (1.70) compared to CFR at endline (0.76) showed a temporal association of a 67% reduced risk for women during the project period (RR: 0.33, 95% CI = .19, .60). Qualitative feedback was used to make course corrections during the project to enhance training and implementation. CONCLUSIONS This implementation project with 280 facilities and over 1000 providers supported via CUG demonstrated that NASG can have high uptake and appropriate use for hypovolemic shock secondary to OH. With the proper implementation strategies, NASG utilization can be high and should be associated with decreased mortality among mothers at risk of death from obstetric hemorrhage.
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Affiliation(s)
| | - Michelle Skaer Therrien
- University of California, San Francisco, School of Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Safe Motherhood Program, California, USA
| | | | | | | | | | | | - Silas Temu
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Suellen Miller
- University of California, San Francisco, School of Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Safe Motherhood Program, California, USA
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Miller S, Burke T, Belizán JM, Fuchtner C, Lalonde A, Malhorta J. Tranexamic acid for post-partum haemorrhage in the WOMAN trial. Lancet 2017; 390:1583. [PMID: 28980957 DOI: 10.1016/s0140-6736(17)32408-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 07/04/2017] [Indexed: 11/21/2022]
Affiliation(s)
- Suellen Miller
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA 94158, USA.
| | - Thomas Burke
- Department of Emergency Medicine, Division of Global Health and Human Rights, Massachusetts General Hospital, Boston, MA, USA
| | - José M Belizán
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Carlos Fuchtner
- International Federation of Gynecology and Obstetrics, Barrio Equipetrol Norte, Santa Cruz de la Sierra, Bolivia
| | - Andre Lalonde
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada; Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
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In Pursuit of Solving a Global Health Problem: Prototype Medical Device for Autotransfusing Life-Threatening Postpartum Hemorrhage in Resource-Limited Settings. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2017. [DOI: 10.1007/s13669-017-0213-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Escobar MF, Füchtner CE, Carvajal JA, Nieto AJ, Messa A, Escobar SS, Monroy AM, Forero AM, Casallas JD, Granados M, Miller S. Experience in the use of non-pneumatic anti-shock garment (NASG) in the management of postpartum haemorrhage with hypovolemic shock in the Fundación Valle Del Lili, Cali, Colombia. Reprod Health 2017; 14:58. [PMID: 28499381 PMCID: PMC5427550 DOI: 10.1186/s12978-017-0325-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 05/03/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this case series is to describe the experience of using the non-pneumatic anti-shock garment (NASG) in the management of severe Postpartum hemorrhage (PPH) and shock, and the value of implementing this concept in high-complexity obstetric hospitals. METHODS Descriptive case series of 77 women that received NASG in the management of PPH with severe hypovolemic shock from June 2014 to December 2015. Vital signs, shock index (SI), the lactic acid value and the base deficit were compared before and after NASG application. RESULTS Fifty-six (77%) women had an SI > 1.1 at the time shock management was initiated; 96% had uterine atony. All women received standard does of uterotonics. The average time between the birth and NASG applications was 20 min. Forty-eight percent of women recovered haemodynamic variables in the first hour and 100% within the first 6 h; 100% had a SI < 1.0 in the first hour. The NASG was not removed until definitive control of bleeding was achieved, with an average time of use of 24 h. There were no mortalities. CONCLUSIONS In this case series of women in severe shock, the NASG was an effective management device for the control of severe hypovolemic shock. It should be considered a first-line option for shock management.
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Affiliation(s)
- María Fernanda Escobar
- Department of Gynecology and Obstetrics, Fundación Clínica Valle del Lili, Universidad ICESI, Cali, Colombia.
| | | | - Javier Andrés Carvajal
- Department of Gynecology and Obstetrics, Fellow of Intensive Care Unit, Fundación Clínica Valle del Lili, Cali, Colombia
| | - Albaro José Nieto
- Department of Gynecology and Obstetrics, Fundación Clínica Valle del Lili, Universidad ICESI, Cali, Colombia
| | - Adriana Messa
- Department of Gynecology and Obstetrics, Fundación Clínica Valle del Lili, Universidad ICESI, Cali, Colombia
| | - Sara Sofía Escobar
- Department of Health Sciences, Medicine School, Universidad ICESI, Fundación Clínica Valle del Lili, Cali, Colombia
| | - Angélica María Monroy
- Department of Health Sciences, Medicine School, Universidad ICESI, Fundación Clínica Valle del Lili, Cali, Colombia
| | - Angélica María Forero
- Clinical Investigation Centre, Department of Gynecology and Obstetrics, Fundación Clínica Valle del Lili, Cali, Colombia
| | - José David Casallas
- Clinical Investigation Centre, Department of Gynecology and Obstetrics, Fundación Clínica Valle del Lili, Cali, Colombia
| | - Marcela Granados
- Internal Medicine, Intensive Care Unit, Fundación Clínica Valle del Lili, Cali, Colombia
| | - Suellen Miller
- Safe Motherhood Programs, Department of Obstetrics, Gynecology & reproductive Sciences, Bixby Center for Global Reproductive Health and Policy School of Medicine, University of California, San Francisco (UCSF), San Francisco, USA
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Hofmeyr GJ, Qureshi Z. Preventing deaths due to haemorrhage. Best Pract Res Clin Obstet Gynaecol 2016; 36:68-82. [PMID: 27450867 DOI: 10.1016/j.bpobgyn.2016.05.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/19/2016] [Accepted: 05/21/2016] [Indexed: 10/21/2022]
Abstract
Prevention of deaths from obstetric haemorrhage requires effective health systems including family planning, commodities, personnel, infrastructure and ultimately universal access to comprehensive obstetric care for women giving birth. The main causes of death associated with antepartum haemorrhage are placental abruption, placenta praevia and uterine rupture. Preventive measures include preconceptual folate supplementation, management of hypertensive disorders, early diagnosis of placenta praevia and use of uterine stimulants cautiously, particularly misoprostol. Preventive measures for post-partum haemorrhage include routine active management of the third stage of labour. Treatment involves a cascade of increasingly invasive interventions in rapid sequence until the bleeding is stopped. These interventions include fluid resuscitation, removal of the placenta, bimanual uterine compression, uterotonics, tranexamic acid, suturing of lower genital tract injury, blood product replacement, balloon tamponade, laparotomy, stepwise uterine devascularization, uterine compression sutures and hysterectomy. Emergency temporizing measures include application of the non-pneumatic anti-shock garment, and at laparotomy, aortic compression and uterine tourniquet application. The effectiveness of treatment methods and the optimal dosage of misoprostol are research priorities. Interesting new approaches include transvaginal uterine artery clamping and suction uterine tamponade.
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Affiliation(s)
- G Justus Hofmeyr
- Effective Care Research Unit, Universities of the Witwatersrand and Fort Hare and Eastern Cape Department of Health, South Africa; Centre for Evidence-Based Health Care, University of Stellenbosch, South Africa; Frere Maternity Hospital, Amalinda Drive, East London, South Africa.
| | - Zahida Qureshi
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, University of Nairobi, Kenya.
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Maswime S, Buchmann E. Causes and avoidable factors in maternal death due to cesarean-related hemorrhage in South Africa. Int J Gynaecol Obstet 2016; 134:320-3. [PMID: 27352737 DOI: 10.1016/j.ijgo.2016.03.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 02/19/2016] [Accepted: 05/19/2016] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To describe risk factors, clinical events, and avoidable factors in cases of maternal death due to bleeding during and after cesarean delivery. METHODS A retrospective study was undertaken of the clinical records of women who delivered in seven hospitals in Johannesburg, South Africa, between January 2013 and December 2014. Maternal deaths due to cesarean-related hemorrhage during or within 42days of cesarean delivery at 24weeks or more were selected. Case records were audited using quantitative techniques to determine the events leading up to death. RESULTS There were 123 251 deliveries and 17 maternal deaths due to bleeding during or after cesarean (3.2 deaths per 10 000 deliveries). Risk factors included previous cesarean delivery, preoperative anemia, and placental abruption. Uterine atony and surgical trauma were the main causes of bleeding. Five (29%) women died before the cause of bleeding was found. Avoidable factors included delays in the recognition and management of shock. Thirteen (76%) women died within 48hours of the cesarean procedure. CONCLUSION Deaths due to bleeding during and after cesarean have multifactorial causation. Maternal healthcare systems must be strengthened, with attention to the knowledge and skills of health workers. This requires increased clinical vigilance, a rapid effective response to obstetric hemorrhage and shock, and overall health system strengthening.
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Affiliation(s)
- Salome Maswime
- Wits Obstetrics and Gynaecology Clinical Research Division, University of the Witwatersrand, Johannesburg, South Africa.
| | - Eckhart Buchmann
- Wits Obstetrics and Gynaecology Clinical Research Division, University of the Witwatersrand, Johannesburg, South Africa
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Jordan K, Butrick E, Yamey G, Miller S. Barriers and Facilitators to Scaling Up the Non-Pneumatic Anti-Shock Garment for Treating Obstetric Hemorrhage: A Qualitative Study. PLoS One 2016; 11:e0150739. [PMID: 26938211 PMCID: PMC4777561 DOI: 10.1371/journal.pone.0150739] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 02/18/2016] [Indexed: 11/19/2022] Open
Abstract
Background Obstetric hemorrhage (OH), which includes hemorrhage from multiple etiologies during pregnancy, childbirth, or postpartum, is the leading cause of maternal mortality and accounts for one-quarter of global maternal deaths. The Non-pneumatic Anti-Shock Garment (NASG) is a first-aid device for obstetric hemorrhage that can be applied for post-partum/post miscarriage and for ectopic pregnancies to buy time for a woman to reach a health care facility for definitive treatment. Despite successful field trials, and endorsement by safe motherhood organizations and the World Health Organization (WHO), scale-up has been slow in some countries. This qualitative study explores contextual factors affecting uptake. Methods From March 2013 to April 2013, we conducted 13 key informant interviews across four countries with a large burden of maternal mortality that had achieved varying success in scaling up the NASG: Ethiopia, India, Nigeria, and Zimbabwe. These key informants were health providers or program specialists working with the NASG. We applied a health policy analysis framework to organize the results. The framework has five domains: attributes of the intervention, attributes of the implementers, delivery strategy, attributes of the adopting community, the socio-political context, and the research context. Results The interviews from our study found that relevant facilitators for scale-up are the simplicity of the device, local and international champions, well-developed training sessions, recommendations by WHO and the International Federation of Gynecology and Obstetrics, and dissemination of NASG clinical trial results. Barriers to scaling up the NASG included limited health infrastructure, relatively high upfront cost of the NASG, initial resistance by providers and policy makers, lack of in-country champions or policy makers advocating for NASG implementation, inadequate return and exchange programs, and lack of political will. Conclusions There was a continuum of uptake ranging in both speed and scale. Ethiopia while not the first country to use the NASG has the most rapid scale-up, followed by Nigeria, then India, and finally Zimbabwe. Increasing the coverage of the NASG will require collaboration with local NASG champions, greater NASG awareness among clinicians and policymakers, as well as stronger political will and advocacy.
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Affiliation(s)
- Keely Jordan
- College of Global Public Health, New York University, New York, New York, United States of America
- * E-mail:
| | - Elizabeth Butrick
- Private Sector Healthcare Initiative, Global Health Group, University of California, San Francisco, United States of America
| | - Gavin Yamey
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Suellen Miller
- Safe Motherhood Program, Bixby Center for Global Reproductive Health, University of California, San Francisco, United States of America
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Miller S, Belizán JM. A promising device to save maternal lives associated with obstetric hemorrhage: the non-pneumatic anti-shock garment (NASG). Reprod Health 2015; 12:26. [PMID: 25890128 PMCID: PMC4392860 DOI: 10.1186/s12978-015-0019-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 03/23/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- Suellen Miller
- Director Safe Motherhood Programs, University of California, San Francisco, School of Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, California, USA.
| | - José M Belizán
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Buenos Aires, Argentina.
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