By Heta Kosonen and Tedbabe Hailegebriel
Post-partum hemorrhage (PPH) – extensive bleeding within the first 24 hours from childbirth – is the leading global cause of maternal deaths. Every year, more than 14 million women suffer from PPH. Nearly 140,000 of them lose their lives.
99 per cent of the PPH related deaths occur in low-resource settings where bleeding women may be hours away from comprehensive obstetric care. Consequently, PPH places a disproportionally large burden on the world’s most disadvantaged mothers, newborns, and children.
A large majority of PPH related deaths could be prevented with timely medical treatment. The healthcare solutions to manage or prevent complications are well-known but inaccessible to many due to the “three delays” that women face while seeking care. The first one is the delay in the decision to seek medical care, the second one is the delay in reaching the adequate health facility in time, and the third delay affects receiving adequate healthcare at the facility. Many women die from bleeding and shock during the second delay due to long distances to emergency health services, particularly in developing countries.
Non-pneumatic anti-shock garment, (NASG) is an innovative device that can help save the lives of the most disadvantaged women and their children. NASG is a lightweight, washable and reusable neoprene compression garment that looks like the bottom half of a wetsuit cut in segments. It can be wrapped around the bleeding mother’s lower body in less than two minutes by anyone who has received a short training. NASG works by reducing the blood flow to the uterus and stabilizes the women suffering from severe PPH while they are waiting to receive definitive care. NASG is needed if the first response with uterotonics, tranexamic acid, IV fluids and uterine massage are not sufficient to stop the bleeding, or if the haemorrhage has been extensive before the application of uterotonics and the woman is in danger of developing hypovolemic shock.
Large evidence-base shows that NASG is effective in reducing maternal mortality. The earlier NASG is applied at the primary healthcare level, the better patients can survive delays in reaching definitive care in referral hospitals. Depending on the context and the use scenario, NASG can save lives with a cost as low as $3/DALY averted. WHO recommends “the use of non-pneumatic anti-shock garments as a temporizing measure until appropriate care is available”. In addition, the use of NASG is recommended as a “best practice” by the International Federation of Gynecologists and Obstetricians (2012).
The Maternal and Newborn Health Unit and the Product Innovation Center organized a joint webinar on NASG in June 2019. Speakers included Professor Suellen Miller from the University of California San Francisco Safe Motherhood program, and Dr. Ghanashyam Sethy from the Papua New Guinea country office. The webinar offered an opportunity for Professor Miller to introduce the audience to the NASG evidence base and for Dr. Sethy to present lessons learned from the UNICEF-led NASG programme in Papua New Guinea. The webinar recording is available here.
NASG can now be procured through UNICEF Supply Division. Interested colleagues can contact Heta Kosonen (firstname.lastname@example.org) or Peter Bollen (email@example.com) for more information. Additional resources, such as training guides, job aids, and synthesized research evidence can be found on the Maternal and Newborn Health and Product Innovation websites.