Low-tech suit could cut maternal deaths

Friday August 12 2011

By TABITHA MWANGI [email protected]

The bright blue garment with large yellow numbers looks like an adult diving suit designed by nursery school children.

There are no chest or arm segments and the space between the legs is exposed.

Yet this suit, known as the Non-pneumatic Anti-shock Garment (NASG), has the ability save thousands of lives of women who suffer from bleeding after child birth — what doctors call post-partum haemorrhage — by extending the time the woman can wait for medical interventions by up to six to 48 hours.

Made from neoprene — the same material used to make diving suits — the suit is wrapped around the mother’s legs, pelvis and abdomen then tightened with velcro straps.

The tightening from the legs upwards applies pressure on the lower body, forcing blood up to the essential core organs: heart, lungs and brain.

On the abdominal segment is a foam pressure ball which applies focused external pressure to the uterus, reducing the bleeding.

Worldwide, 14 million women suffer from bleeding after giving birth. If not controlled, the loss of blood causes the woman to go into shock.

When in shock, the brain, heart and lungs are deprived of oxygen because blood accumulates in the lower abdomen and legs.

This is an emergency condition which can cause severe organ failure and death.

Death is swift, often within two hours from when the bleeding starts.

Every year, over 150,000 women die due to post-partum haemorrhage, which translates to a woman dying every four minutes.

Ninety-nine percent of these deaths are in developing countries.

There is, however, a dearth of information on the actual numbers of women dying due to post-partum haemorrhage.

Dr Bryn Kemp, a consultant obstertician-gynecologist from the UK, is currently at the Kilifi District hospital setting up a maternal health surveillance system.

“At the Kilifi District Hospital, we are well equiped to prevent and manage post-partum haemorrhage and, therefore, don’t see huge numbers of cases,” says Dr Kemp.

“Bear in mind that only 30 percent of the mothers within the catchment area of Kilifi District Hospital deliver at this health facility.

“Post-partum haemorrhage, when it happens, is acute, a mother loses 1.5 litres of blood a minute from the uterine artery.

“It does not take long for her to bleed to death.

“I don’t know what the true picture is outside the hospital setting, but due to the nature of the condition, a mother living far from a hospital is unlikely to survive a transfer.

“A NASG would buy such a woman time to get to help.”

Dr Sullen Miller, director of safe motherhood, has been critical in leading studies to show the effectiveness of NASG in Nigeria and Egypt.

In the period from 2004 to 2008, 1,442 women were recruited into the study.

The NASG were demonstrated to reduce maternal deaths by more than half and to reduce the probability of a mother having emergency removal of her uterus (hysterectomy) by 56 percent.

Putting a NASG on a woman at a primary health centre can have immediate dramatic results.

“Once a woman, regardless of the state of shock, is placed in the NASG, the response is seen almost immediately, the pulse slows, the blood pressure rises, the woman regains consciousness and the bleeding diminishes,” Dr Miller said.

Doctors doing the studies in Nigeria have observed people in mourning for a woman brought to a health facility watch in awe as the woman was resuscitated using a NASG and start to talk as though raised from the dead. The use of NASG has in these areas built faith in hospital deliveries.

The studies so far directed by Dr Suellen Miller have been focused in referral hospitals but the NASG will be of most benefit in primary health care centres such as dispensaries, where the mothers are first taken before referral.

Studies are being conducted to determine the utility of NASG in these settings.

The NASG is a first-aid and not a definitive treatment.

A woman in a NASG still needs to receive blood transfusions, surgery and other definitive interventions.

The use of the NASG, however, lowers panic levels and has been proposed to be the reason why significantly fewer women on NASG underwent a hysterectomy compared to those that were not wrapped in the garment.

Other procedures to locate the source of the haemorrhage and attend to it can also be done with the NASG still in place as the perineal area is exposed.

If the NASG is worn properly, immediately washed on removal, hung to dry and folded well, it can be used about 40 times.

Although costing $170 (Sh16,000) per garment, this cost is spread over 40 women resulting in a total cost of $4.25 (Sh380) per treatment.

If these garments are to be distributed in health centres, dispensaries and hospitals within the African continent, the cost is likely to be high.

A non-profit organisation known as the Program for Appropriate Technology in Health (PATH), which makes available simple technologies that impact the health of people in poor countries, has begun to focus attention on the NASG.

Paul Labarre, technical officer on the technology solutions team at PATH says the positive results expected from Dr Suellen Miller’s research will lead to stronger endorsement in the WHO guidelines on management of post-partum haemorrhage and will open the door to increased uptake of the garment within Africa.

“PATH is currently funded to establish distribution of NASG in Africa and we anticipate that distribution channels will be established within 12 to 18 months,” Paul Labarre said.

Even with the anticipated availability of NASG within the continent, there is still a long journey to be made to bring maternal mortality rates down.

“I am staggered that there is so little research in Sub-Saharan Africa on maternal mortality.

“There is not good enough data to describe the problem, let alone instigate interventions to try and address the problem,” Dr Kemp said.

A true picture of the actual causes of the burden of maternal mortality is difficult to predict since more than half the population deliver away from a health care facility but it is a first step in working out ways of reducing the burden.