Technical assistance for Integration of NASG for Obstetric Hemorrhage

Investigator: Suellen Miller, PhD, CNM, MHA
Sponsor: John Snow, Inc

Location(s): Egypt


The Non-pneumatic Anti-Shock Garment (NASG)

What is it?
The NASG is a simple neoprene and Velcro device much like the bottom half of a wet suit split down the middle.

How does it work?
When in shock, the brain, heart, and lungs are deprived of oxygen because blood accumulates in the lower abdomen and legs. The NASG reverses shock by returning blood to the vital organs. This will restore the woman’s consciousness, pulse, and blood pressure. Additionally, the NASG slows blood flow to the lower body and decreases bleeding.

How is the NASG used?
After a simple training session, anyone can put the garment on a bleeding woman. Once her bleeding has stopped, she can be safely transported from a home birth or primary health care center to a referral facility for emergency obstetrical care. 

Results of NASG studies

We have synthesized the findings from five NASG studies conducted at tertiary care facilities into a meta-analysis, a statistical method for examining and combining data from multiple studies.  These five NASG studies were:  Egypt (2006); Nigeria and Egypt combined (2010); Lusaka, Zambia and Harare, Zimbabwe combined (2012); Copperbelt, Zambia (2012); and the Pathfinder India RAKSHA implementation project (2012). (See reference list for full citations.)  Combining the data from these different studies in a meta-analysis provided a larger sample size, and thus greater statistical “power”. Having adequate statistical power means that the sample is big enough to avoid missing a real difference between the treatment (NASG) and the non-treatment groups because the sample size is too small.

In addition, by combining our results we examined how the NASG works over a range of countries, from relatively middle income settings with lower maternal mortality (Egypt) to very low resource settings with high maternal mortality (Copperbelt, Zambia), and from strictly monitored, highly trained researchers/clinicians (Egypt), to implementation projects with little research supervision (India).  All of the studies used a quasi-experimental design, which means that women were not randomized.  Four studies had a pre-intervention/intervention design, and in the India RAKSHA Project, clinicians either used the NASG or did not use it in the same facilities on similar patients.

The five studies included 3,561 women with severe obstetric hemorrhage and hypovolemic shock; 1,614 (45%) were treated with standard care PLUS the NASG and 1,947 (55%) received standard care only.  Of these 3,561 women, about one-third (n=1,227) of women were in the most severe shock, with evidence of decreased oxygen to their brain, heart and lungs.

The pooled results for all women showed a 38% decrease in mortality among women who received the NASG, while the reduction in mortality was even greater for those in the worst condition, at 63%.  Further, data from all studies demonstrated no safety issues from using the NASG.

META ANALYSIS CONCLUSION:  At the tertiary hospital level, the NASG plus standard care significantly reduces mortality, especially for women in more severe shock. The Odds Ratio for mortality for all participants was OR 0.62, 95% CI 0.44-0.86, and OR 0.37, 95% CI 0.25-0.56 for the most severe cases.