Fig 1) Blood pressure conservervation with vs without the LifeWrap NASG

BP with-without NASG image 20140820About the LifeWrap NASG

The Non-Pneumatic Anti-Shock Garment (NASG) is a lightweight (1.5kg), washable and reusable first aid compression device made of neoprene fastened with velcro over a foam compression ball.  Once in place, the LifeWrap NASG applies enough circumferential counter pressure to decrease blood loss and reverse shock by increasing blood pressure to the heart, brain, and lungs.  In so doing, it reverses hypovolaemic shock resulting from Obstetric Haemorrhage, and has proven effective in stabilising patients for up to 3 days, while patients are transported to a health centre with the ability to administer blood transfusions and provide definitive medical or surgical interventions.

 

 

 

 

Postpartum Haemorrhage (PPH) mortality

Postpartum Haemorrhage (PPH), commonly defined as blood loss of 500mls or more within 24hrs after birth, is the leading cause of maternal mortality in most low-income countries.  Approximately 2% of all pregnancies are affected by PPH and nearly one quarter (1) of the 287,000 maternal deaths globally (2) are associated with it.  Most of these deaths occur within the first 24 hours of delivery (3) as a result of complications in the third stage of labor.  When uteronic drugs are unavailable or are ineffective in preventing PPH, women can quickly undergo heavy bleeding and enter into hypovolaemic shock.  The required medical interventions to treat such conditions are often not available in low-resource settings, where deliveries can occur far from health facilities, or where facilities do not have the necessary resources.

 

Effectiveness of the LifeWrap NASG

Although it has been used in the US for pre-hospital lower body trauma, the device was not used for obstetric haemorrhage in limited resource settings until 2002(4).  Since this time, a steady body of evidence has been built up, based on clinical trials conducted by the Safe Motherhood Program, University of California, San Francisco and international colleagues in Egypt, Nigeria, Zambia, Zimbabwe and India.  In an analysis of 5 smaller studies, with a total of 3,563 patients of which 1,614 were treated with the NASG and 1,947 received standard of care in each respective country.  After pooling results from these trials, a 38% reduction in maternal mortality was observed in women who received the NASG and a 63% reduction in mortality was achieved for women in most severe shock.(5)  Across clinical trials and pilot projects, the NASG has now been used in over 5,000 women and has demonstrated a 40-80% reduction in mortality across various settings in a number of low- and middle-income countries.(6)  As a direct consequence, in 2012 NASG's were included in the WHO Recommendations on Prevention and Treatment of Postpartum Hemorrhage as a temporizing measure until appropriate care is available.(7)

1) WHO Recommendations for the prevention and Treatment of Post Partum Haemorrhage. Available at http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/9789241548502/en/ (November 2012). 2) Institute for Health Metrics and Evaluation. 2010; United Nations "Trends in Maternal Mortality:1990 to 2010". 2012. 3) PSI. "Accelovate Market Analysis for Magnesium Sulfate, Misoprostol and Oxytocin." 2012 4) Hensleigh PA (2002) Anti-Shock garment provides resucitation and haemostasis for obstetric haemorrhaging. BJOG 109:1377-1384 5) El Ayadi, A; Butrick, E; Geissler, J; Miller, S. (2013) Combined Alnalysis of the Non-pneumatic Anti-Shock Garment on mortality from Hypovolemic Shock Secondary to Obstetric Hemorrhage. BMC Pregnancy & Childbirth: 13(208)/ University of California 6) Suellen Miller, UCSF 7) WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage