The use of antishock garment in Obs and gynae

The use of antishock garment in Obs and gynae

1. THE USE OF NON PNEUMATIC
ANTISHOCK GARMENT IN THE
MANAGEMENT OF
POSTPARTUM HAEMORRHAGE
BY
DR. AYODELE NOSRULLAH S.
1

2. OUTLINE
INTRODUCTION
HISTORICAL BACKGROUND
INDICATIONS FOR USE
ADVANTAGES
THE DEVICE
STRUCTURE
MECHANISM OF ACTION
APPLICATION/REMOVAL
CHALLENGES
CONCLUSION
REFERENCES
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3. INTRODUCTION
Postpartum haemorrhage (PPH) is the
world’s leading cause of maternal
mortality.
1
It is defined as the loss of 500ml or more
from the genital tract after delivery or of
any volume that compromises the clinical
condition of the paturient.
2
3

4. INTRODUCTION
Worldwide, maternal mortality ratio is
estimated at 216:100,000 (as at 2015) with
99% occurring in developing countries
3
In Nigeria, is put at 576:100,000 as at 2013
8
PPH in developing countries continues to be
the single most common cause of maternal
morbidity and mortality, accounting for
approximately 25% of maternal deaths
globally.
4
4

5. INTRODUCTION
Over 90 percent of these deaths occur in
developing countries therefore, it needs emergency
treatment to preserve the live of the patient.
For women suffering from uncontrollable PPH, a
method to control the bleeding, reverse the shock,
and stabilize the patient for safe transport to a
comprehensive obstetric care facility would be
lifesaving
Non-pneumatic antishock garment (NASG) is one
of the various ways of managing (PPH)
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5

6. HISTORICAL BACKGROUND
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In the 1900s an inflatable pressure suit was
developed by George Crile, used to maintain
blood pressure during surgery.
In the 1940s after some numerous modifications,
the suit was refined for use as an anti-gravity suit
(G-suit)
In the 1970s the G-suit was modified into a half-
suit which became known Military Anti Shock
Garment (MASG)or Pneumatic Anti-Shock
Garment(PASG)

7. HISTORICAL BACKGROUND
Further modifications led to the development
of Non-pneumatic Anti-Shock Garment
(NASG)
The use of the NASG for obstetrical
hemorrhage in low-resource settings began in
2002 when Dr. Carol Brees and Dr. Paul
Hensleigh introduced the garment into a
hospital in Pakistan and reported on a case
series of its use.
7

8. INDICATION FOR USE
The NASG could be used to manage
any condition where there is severe
bleeding below the diaphragm.
Studies have documented use with all
forms of obstetric hemorrhage, as long
as the fetus is not viable in utero.
6
8

9. INDICATORS OF SHOCK
Notably NASG is used in cases of shock
eg caused by postpartum haemorrhage.
Characterised by
Rapid, weak pulse (>100bpm)
Rapid, shallow breathing
Restlessness
Pale, cool, clammy skin
Altered sensorium
Dropping blood pressure (Systolic
<90mmHg)
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10. Advantages of NASG
Light-weight (1500g), reusable
50-78% Reduction in blood loss
Reverses shock
50-55% Reduction in Maternal Mortality &
related Morbidity
Cost effective
Permits complete perineal access
Gives room for surgical intervention
WHO includes NASG in recommendations
5

11. THE DEVICE (aka life wrap)
The device is a non-inflatable garment
that produces circumferential pressure
on the lower extremities and abdomen
with no need of tubes, pumps, valves or
gauges.
The pressure is performed through the
elasticity of the neoprene material
maintained by the Velcro
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12. THE DEVICE (STRUCTURE)
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13. THE DEVICE (STRUCTURE)
It is a light weight Compression suit made
of Neoprene and Velcro fastenings to
keep garment tight
Six segments enclosing ankle, calves,
thigh, pelvis & abdomen
A small foam ball in the abdominal
segment applies pressure on the uterus
Markings on the sections show how to
apply

14. MECHANISM OF ACTION
The NASG provides enough counter pressure,
pushing blood from the lower extremities into
central circulation, making sure there is
sufficient blood getting to the vital organs
(brain, heart and lungs).
The foam ball over the abdomen applies
pressure to the blood vessels of the uterus,
decreasing blood flow.
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15. NASG
Obstetric
Hemorrhage

16. APPLYING THE DEVICE
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17. APPLYING THE DEVICE
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Step 1:
Place NASG under the woman with the top at
the level of lowest rib
Close segment 1 tightly around ankle on both
sides
Place a finger under the segment and snap it
until you hear a sharp sound
Step 2:
Close segment 2 around calf muscle
Leave the knee joint free

18. APPLYING THE DEVICE
Step 3:
Apply segment 3 around the thighs
Step 4:
Apply segment 4 all around the woman
with the lower edge at the level of pubic
bone

19. APPLYING THE DEVICE
Step 5:
Place segment 5 with pressure ball
directly over umbilicus
Close the NASG using segment 6
Only one person should close segment
4 & 5
Should not be too tight to restrict
breathing

20. APPLYING THE DEVICE
Step 6:
Ensure patient is breathing normally after
the application
In case of uterine atonyadminister
uterotonics& massage the uterus without
removing the NASG
NASG is flexible enough to allow the
massaging

21. APPLYING THE DEVICE
To apply the NASG to a short woman:
Step 1
If the woman is short, fold segment #1
to the inside of segment #2
Begin with segment #2 at her ankles.
Steps 2-4
Apply segment #3 to the thighs, as
usual. Continue with the rest of the
segments as with all women. 21

22. APPLYING THE DEVICE
Application if the Woman is Unconscious
Will require 2 people to position the
garment beneath her. The final
segment, however, should still be closed
using only the strength of one person
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23. REMOVING THE DEVICE
6
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24. WHEN TO REMOVE NASG?
Patient must be stable for 2 hours
Bleeding <50 ml/hr
Pulse <100 BPM
Systolic BP 90-100 mm Hg
Hb >7G% or Hct >20%
Patient conscious & alert

25. HOW TO REMOVE NASG?
Remove segment 1 & wait for 15 mts
Check pulse & BP
If pulse rate increases >20 BPM or BP falls
by 20 mm Hg: Reapply segment 1 (rule of
20)
If vitals stable remove segment 2
Follow same principles till removal of
segment 6

26. * PRECAUTION *
Do not remove NASG before all vital
signs are restored
Early removal of NASG or removal in
wrong order can be dangerous or even
fatal
Consider need for crystalloids / Blood
If recurrent bleeding, replace all
segments, determine source and arrest
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27. * PRECAUTION *
Monitor urine output.
Ensure airway protection and
aspiration prevention as required.
Ensure one-on-one nursing care
throughout.
Never open the abdominal panel first.
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28. CHALLENGES
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Cleaning difficulties
Storage difficulties
Availability of adequate size
Its use is not definitive intervention, the
need for substantive PPH treatment (such
as uterotonics, blood transfusion) remains.
Implementation requires frequent training
and supportive supervision
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29. CONCLUSION
NASG is a temporizing alternative measure in
PPH management that shows a trend to reduce
PPH-related deaths and severe morbidities.
In settings where delays in PPH management
are common, particularly where constraints to
offer blood products and definitive treatment
exist, use of NASG is an intervention that should
be considered as a policy option while the
standard conditions for care are being optimized.
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30. REFERENCES
1.Say L, Chou D, GemmillA, TunçalpÖ, Moller A-B, Daniels J, et al. Global causes
of maternal death: a WHO systematic analysis. Lancet Global Health.
2014;2(6):e323–33.
2.Akin Agboola, Textbook of Obstetrics and Gynaecologyfor Medical Students,
2
nd
edition, 59:481
3.Trends in maternal mortality: 1990 to 2015: estimates by WHO, UNICEF,
UNFPA, World Bank Group and the United Nations Population Division. WHO
2015
4.World Health Organization: Compendium of new and emerging technologies
that address global health concerns 2011
5.World Health Organization: Recommendations for the prevention and
treatment of postpartum haemorrhage, Geneva Switzerland: World Health
Organization Library; 2012
6.Pathfinder International: Prevention, Recognition, and Management of
Postpartum Hemorrhage Trainer’s Guide; May, 2010; 103-118
7.https://en.wikipedia.org/wiki/Non-pneumatic_anti-shock_garment
8.Nigeria Demographic and Health Survey, NPC FRN, 2013; 14:301
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31. THANK YOU
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