The UCSF Safe Motherhood Program is proud to announce the publication of “Comorbidities and Lack of Blood Transfusion May Negatively Affect Maternal Outcomes of Women with Obstetric Hemorrhage Treated with NASG” in the PLOS ONE Open Access Journal.
This paper was co-authored by Dr. Alison El-Ayadi, Elizabeth Butrick, MSW/MPH, and Professor Suellen Miller of the UCSF Safe Motherhood Program, Bixby Center, Department of Ob/Gyn. & Reproductive Sciences; Sarah Raifman, MPH, of the Harvard School of Public Health’s Department of Global Health and Population; Dr. Farouk Jega and Yemisi Ojo of Pathfinder International; and Professor Stacie Geller of the University of Illinois Chicago School of Medicine, Department of Ob/Gyn.
The paper outlines findings from data collected on 1149 women who received the NASG for hypovolemic shock due to obstetric hemorrhage at 50 facilities in seven states in Nigeria between 2007 and 2012. The NASG was implemented as part of Pathfinder International’s Clinical and Community Action to Address Postpartum Hemorrhage Project in Nigeria.
Data were collected on every woman in severe shock who received the NASG. In analysis, characteristics were compared between women who survived with NASG and women who did not survive with NASG. The mortality among these severely ill women was 17.5%. Death in the NASG was strongly associated with a woman having a comorbidity, such as anemia, eclampsia/preeclampsia, or sepsis. Likewise, a woman carrying a dead fetus or having a macerated stillbirth was more likely to die, most likely from coagulation problems. Women who did not receive a blood transfusion were nearly four times more likely to die than women who did.
This paper is the first to be published on the use of the NASG outside of clinical trials and was produced to describe the real-world experience of using the NASG. The findings reinforce and demonstrate many of the UCSF Safe Motherhood Program’s and Pathfinder International’s hypotheses about the NASG:
1. Use of the NASG reduced mortality among women in hypovolemic shock due to obstetric causes when used in real-world settings.
2. The NASG is not a replacement for blood transfusions or definitive care. It is a first-aid device that will help overcome delays in the system. A Continuum of Care Approach (from prevention to definitive treatment) is necessary for optimum maternal health outcomes.
3. A staff well-trained to handle complicated emergency obstetrical care should be looking not only for hemorrhage, but also for comorbidities that might need other treatments, particularly eclampsia and sepsis.
4. Well-trained staff should recognize and manage a woman carrying a dead fetus rapidly before coagulation problems develop.
5. NASG use in real-world settings allows for evaluation and building of the knowledge base without the need to conduct major epidemiological trials.
These findings underscore not only the effectiveness of the NASG, but also the need for multi-system assessment and a comprehensive approach to the treatment of women with pregnancy complications.