NASG: A First-aid Device for Obstetric Hemorrhage Within a Comprehensive Approach to Maternal Health Care
Ever since the first evidence emerged from clinical trials to suggest that the non-pneumatic anti-shock garment (NASG) can be effective in addressing obstetric hemorrhage, the garment has emerged as a potentially vital first aid device for reducing maternal mortality in settings where there are long delays in reaching care. In spite of this promise, there has, until recently, been little evidence on how the NASG works in real-world settings. In “Comorbidities and Lack of Blood Transfusion May Negatively Affect Maternal Outcomes of Women with Obstetric Hemorrhage Treated with NASG ,” was published in August, by PLOS One the authors examined factors associated with mortality among women in a continuum of care for PPH project set in Nigeria. Recently, the three of the article’s authors, Alison El Ayadi and Suellen Miller of the University of California at San Francisco Bixby Center for Global Reproductive Health, and Farouk Jega of Pathfinder International, took some time to discuss the project and their findings with the MHTF.
Throughout our conversation, the authors emphasized a few main findings: that certain comorbidities; as well as simply not receiving essential interventions, such as blood transfusions, can mean that women whose bleeding is effectively controlled by the NASG may still die. This has critical implications for efforts to provide comprehensive, high quality care. As Dr. Miller pointed out, “Every woman is at risk of postpartum hemorrhage, but some women are at a higher risk of dying from their postpartum hemorrhage.” She continued, “Conditions like macerated stillbirth are at highest risk, both because they may lead to the most dangerous form of hemorrhage, disseminated intravascular coagulopathy (DIC), but also because the staff may pay less attention to the woman who is no longer carrying a live fetus.”
The researchers pointed to ways in which introducing the NASG presented something of a paradox: while helping fill some of the chronic gaps in health service delivery, it underscored just how fundamental the need for comprehensive care is. As Dr. Jega said, in clinics where health workers regularly face supply shortages and overwork, “The health workers believed that the garment was a magic wand,” when they saw how the NASG could work to slow bleeding, and improve vital signs of women in shock. The project showed that the NASG is most valuable as part of the continuum of care. In many cases, as Dr. Miller pointed out, “Stopping the bleeding is not enough. Attention must be paid to the whole woman.” In fact, the women most at risk of dying often had other complications, such as eclampsia, which can be masked by the symptoms of postpartum hemorrhage. Further, as Dr. Jega said, “The NASG gives healthcare workers a false sense of security – when women are stabilized – and because they are really overworked, the workers will just go on to something else,” even as women may still require close monitoring. That is, the researchers suggested, the project demonstrated that the NASG is a first aid device that underscores the importance of comprehensive, high quality maternal health services. In other words, the project further shows that for as much as health workers, program managers or donors might like a “magic wand” to emerge, this is unlikely. First aid devices like the NASG have the capacity to save lives, but it would be a mistake to treat them as alternatives to investments in comprehensive approaches.
The recent PLOS One article is, of course, just the beginning. As the Pathfinder/UCSF team continues to share its findings, we look forward to learning more about the NASG, as well as the lessons their work holds for comprehensive approaches to improving maternal health care in low resource settings.
Post updated October 25