12:00 AM, July 21, 2013 / LAST MODIFIED: 10:14 PM, July 20, 2013

A unique first aid device for obstetric bleeding

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Dr Tareq Salahuddin

Demonstration of a non-pneumatic anti-shock garment (NASG) - also called a “lifewrap" - to stop post-partum haemorrhage at a seminar in the Women Deliver conference in Kuala Lumpur, Malaysia in May 2013.PHOTO: DR TAREQ SALAHUDDIN Demonstration of a non-pneumatic anti-shock garment (NASG) - also called a “lifewrap" - to stop post-partum haemorrhage at a seminar in the Women Deliver conference in Kuala Lumpur, Malaysia in May 2013.PHOTO: DR TAREQ SALAHUDDIN

The leading cause of maternal mortality (deaths from pregnancy and childbirth related complications) is obstetric haemorrhage in which a woman bleeds heavily, most often immediately after giving birth. A woman somewhere in the world dies every 4 minutes from this kind of complication. The LifeWrap (generic name: Non-pneumatic Anti-shock Garment or NASG) is a first-aid device used to stabilise women who are suffering from obstetric haemorrhage and shock. It is made of neoprene and VelcroTM and looks like the lower half of a wetsuit, cut into segments.
This simple device helps women survive delays in getting to a hospital and getting the treatment that they need. It can be applied by anyone after a short, simple training. To date, it has been used on over 6,000 women in 6 countries.
After a simple training session, anyone can put the garment on a bleeding woman. Once her bleeding is controlled, she can be safely transported to a referral hospital for emergency obstetrical care. The Lifewrap is light, flexible and comfortable for the wearer. It does not need to be removed for uterine massage, examinations or vaginal procedures, with the abdominal part only being opened for abdominal surgery. Upon application a patient’s vital signs are often quickly restored and consciousness regained.
In the 1900s an inflatable pressure suit was developed by George Crile. It was used to maintain blood pressure during surgery. In the 1940s and after undergoing numerous modifications, the suit was refined for use as an anti-gravity suit (G-suit). Further modification led to its use in the Vietnam War for resuscitating and stabilising soldiers with traumatic injuries before and during transportation. In the 1970s the G-suit was modified into a half-suit which became known as MAST (Military anti-shock trousers) or PASG (Pneumatic Anti-Shock Garment).
During the 1980s the PASG garment became used more and more by emergency rescue services to stabilise patients with shock due to lower body haemorrhage. During the 1990s the PASG was added to the American College of Obstetrics and Gynecology.
From the 1970s, NASA/Ames was involved in developing a non-pneumatic version of the anti-shock garment. This was originally used for haemophiliac children, but has since been developed into the garment known as the Non-pneumatic Anti-Shock Garment (NASG).
The non-pneumatic anti-shock garment is now off-patent and produced in several different locations.
The use of the garment for obstetrical haemorrhage 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.
Dr. Suellen Miller and colleagues in Mexico, Egypt and Nigeria have completed studies of the NASG (also named the LifeWrap) for obstetric haemorrhage in hospitals in these countries with studies ongoing at primary health care centers in Zambia and Zimbabwe.
An implementation programme with the NASG as part of a Continuum of Care for Post-Partum Haemorrhage (CCPPH) has been underway since 2008 in India, Nigeria, Tanzania and Peru. The NGO Pathfinder International is the lead implementing organisation on the CCPPH project. Dr. Suellen Miller has done extensive clinical trials with the device as an obstetric first aid. The U.S. based non-profit organisation, Pathfinder International has worked on developing the Continuum of Care model.
The lifewrap is not designed as a final solution to save women, but only a stabilising measure to buy her time to be transferred to a health facility for surgery or blood transfusion.
It can be a great life-saving tool for the delivering mothers in remote communities of developing countries who give birth mostly at home.
A cost-effective analysis of results from the Nigeria and Egypt studies demonstrated markedly improved health outcomes with net savings or extremely low cost per disability-adjusted life years (DALYs). Cost per use is approximately $1.50.

E-mail: tareq.salahuddin@thedailystar.net
For more information, visit http://www.lifewraps.org

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