A woman suffering from postpartum haemorrhage can die within two hours unless she receives immediate and prompt medical care; therefore, when delay in managing postpartum haemorrhage occurs, first aid is needed to resuscitate and stabilize women with hypovolemic shock. One of the ways to address this problem is with the use of a lightweight, cost-efficient compression garment, the non-pneumatic anti-shock garment (NASG), which stabilizes women who have lost excessive blood, allowing them to survive delays in travelling to or receiving care at CEmOC facilities.
The Non- pneumatic Anti-Shock Garment (NASG) is a unique, Life -saving first -aid device made of neoprene and Velcro, which is used on women with obstetric hemorrhage. It can be applied by anyone, with minimal training. The NASG has a unique role in hemorrhage and shock management, because it is meant to be used with, not instead of, other technologies. Currently, it is the only tool that aids in stabilizing pulse and blood pressure after a woman has gone into shock from obstetric hemorrhage. NASG can reverse shock and can be used at the same time with other hemorrhage and shock treatments, such as: Uterine massage, uterotonics, blood transfusions,vaginal procedures and surgery ,uterine balloon tamponade.
The NASG acts by reversing hypovolemic shock due to PPH and returns blood to heart, lungs, and brain by applying pressure to the lower body and abdomen. The use of an NASG can stabilize a patient while awaiting transport, during transport, or during delays in receiving care at referral facilities.NASG is mainly useful to stabilize a patient while evaluating, transporting, and preparing for definitive surgical treatment .A woman can safely and comfortably wear the NASG for up to 48 hours. The NASG remains on the woman during treatments and until she has been hemo-dynamically stable for 2 hours.
NASG has 6 segments. segment 1, 2, and 3 (in pairs) are placed around the patient’s legs ,segments 4, 5, and 6 are placed around pelvis and abdomen, A ball in segment 5 and segment 6 is placed over the woman’s umbilicus , adding more pressure on postpartum uterus. Segment 6 is closed over segment 5.
Indications for the use of NASG are -to manage any condition, where there is severe bleeding below the diaphragm ,all forms of obstetric hemorrhage (in excess of 750 ml) like in ectopic pregnancy, abruption, acute or chronic, placenta praevia, ruptured uterus, hydatidiform mole, spontaneous abortion. After delivery NASG is used in uterine atony, retained products of conception, obstetrical trauma.
The contraindications for the use of NASG are -A viable fetus (unless there is no other way to save the mother’s life and both mother and fetus will die), bleeding above diaphragm, open thoracic wounds, patients with severe congestive heart failure or pre-existing mitral stenosis. In trauma victims with injury to the chest or head, redistribution of blood to the injured area with NASG placement raises the possibility of associated increased hemorrhage.
Despite successful field trials, and endorsement by safe motherhood organizations and the World Health Organization (WHO), scale-up regarding the use of NASG has been slow in some countries including India. Increasing the coverage of the NASG will require collaboration with local NASG champions, greater NASG awareness among clinicians and policymakers, as well as stronger political will and advocacy.