NASG Reduces Mortality in Indian Women with PPH

Acknowledgements

Participating Facilities

Bihar

Rajasthan

Thank you!

Zenana Hospital (MCH)

Khurabad (CHC)

Badgaon (CHC)

Jhadol (CHC)

Phalasia (CHC)

Objective

PATNA Medical College HospitalNalanda Medical College HospitalDhanura (PHC)Masurahi (PHC)Paliganj (PHC)HAJIPUR (DH)BIDUPUR (PHC)MOHUA (PHC)

Maharastra

To compare outcomes of Indian women with postpartum hemorrhage (PPH) and hypovolemic shock treated with:

Beed

Kaij

Parli

Dharur

SRTRMCH,Ambageogai

Tamil Nadu

RSRMKMCKGHIOG

Standard hemorrhage and shock management

vs

Background

Standard hemorrhage and shock management

+

Non-pneumatic Anti-Shock Garment (NASG)

The NASG was introduced in the context of the

RAKSHA Project

Conclusions

A PPH Continuum of Care project implemented by Pathfinder International in 22 facilities in 4 states in India

• The RAKSHA Implementation Project allowed documentation of a decrease in maternal mortality of women treated with NASG, especially of those in worse condition

Bihar

NASG REDUCES MORTALITY IN INDIAN WOMEN WITH PPH

Rajasthan

• Despite small sample size and lack of randomization, magnitude of effect similar to published results of NASG trials in Nigeria and Egypt (Miller, 2010)

Maharshtra

Dr. Sudhir Maknikar, MD

• Larger, randomized trial may show greater effect and efficacy with greater reliability

Tamil Nadu

Dr. Rema Nanda, PhD

Senior Technical Advisor, Maternal and Child Health

Pathfinder International, Delhi

India Country Representative

Director, Safe Motherhood Program

University of California, San Francisco

Prof. Suellen Miller, CNM, PhD

Patient Characteristics

October 8, 2012

Materials

Place of Delivery

Non-Pneumatic Anti Shock Garment :

a circumferential counterpressure first aid device

Methods

Hospital Deliveries

Standard Care

NASG

Level of Consciousness

54

60

2 Year Project:

April 1, 2010-March 31, 2012

NASG

p-value

Standard Care

(38.9%)

(49.6%)

118,893

total deliveries

n=139 (53.5%)

n=121 (46.5%)

p-value = 0.08

1,541

women with severe PPH (>1000mL EBL (~1%))

Normal

0.07

68 (60.7%)

71 (51.5%)

260

(16.9%) with hypovolemic shock

Agitated/ Confused

55 (39.6%)

37 (30.6%)

Blood Transfusions

Unconscious

13 (9.4%)

16 (13.2%)

• Hemodynamic changes

Standard Care

NASG

(BP systolic<100mmHg or Pulse>100BPM)

(46.5%)

(53.5%)

139

121

• Changes in sensorium

102/139

NO NASG

APPLIED NASG

86/121

p-value

=0.07

Protocol: NASG was applied to all eligible women, this did not always happen

73.4%

71.1%

Outcomes - Mortality

All Patients

• Outcomes compared between women who received the NASG and those who did not

p-value = 0.69

NASG

p-value

Standard Care

• Means and medians compared using t tests

n=121 (46.5%)

n=139 (53.9%)

• Percentages compared with χ and Fischer exact test

Survived

86 (71.1%)

0.07

112 (80.6%)

Died

35 (28.9%)

27 (19.4%)

Outcomes - Mortality

Severe Shock Only

NASG

p-value

Standard Care

n=69 (56.6%)

n=53 (43.4%)

<0.01

Survived

22 (41.5%)

50 (72.5%)

Died

19 (27.5%)

31 (58.5%)