Ending the Maternal Mortality Crisis: An Update on the Non-Pneumatic Anti-Shock Garment

The Non-Pneumatic Anti-Shock Garment (NASG) is a first aid compression garment that reverses hypovolemic shock and increases the likelihood of survival in women before, during, and after childbirth. Muso, in its mission to end the maternal mortality crisis, launched training three months ago for the use of this garment in Mali and Côte d'Ivoire, where maternal mortality rates remain high. We sat down with Dr. Mamadou Keita, Chief Gynecologist at the Referral Health Center (CSREF) of Bamako's Commune 6 to talk about the impact of this tool since its launch.

*Parts of the interview have been edited for clarity of translation

Dr. Mamadou Keita, Chief Gynecologist at the Referral Health Center (CSREF) of Bamako's Commune 6 demonstrating rescue techniques to health care professionals during the NASG training.

The Non-Pneumatic Anti-Shock Garment (NASG) against Obstetrical Hemorrhage (OH) has been available at the CSREF of Bamako's Commune 6 since June 2022. What has been your experience so far?

Mamadou Keita (M.K.): The impression we have is that it is a great addition because it has strengthened our arsenal for the management of immediate postpartum hemorrhage (PPH). Since its launch - from June to now - we have had about 10 cases in which we used the NASG. For instance, in cases where blood for transfusion was not immediately available, or when the patient needed to be resuscitated prior to surgery - depending on the extent of the shock. There are also patients on whom we have applied the garment before evacuating them to better-supplied hospitals in order to stabilize them.

How many anti-shock vests do you have in the center and how do you maintain them?

M.K.: We have seven garments right now, and we have put four of them in circulation. Two of them live in the operating room and two are in the delivery room. Before we started using the garment in our center, all the departments (anesthesiologists, instrumentalists, midwives, interns, etc.) involved in the management of hemorrhage were trained, and this has made maintenance easier. The garments in the delivery room are regularly cleaned, dried, and stored, and the same protocol is followed for the ones in the operating room.

How was the training structured?

M.K.: The training was done in two sessions of 25 providers each - about 50 people in total. But beyond that, there were knowledge-sharing sessions for the rest of the operating room staff who were not present in the original sessions. After the training, the staff saw a real impact, but what made it more powerful was when the training diplomas were sent out - they were even more motivated than before. Muso sent out diplomas with each nurse's name on them after the training ended, and the staff was very moved by this recognition.

As one of the busiest health centers assisting pregnant women, do you frequently have cases of OH?

M.K.: The majority of hemorrhage cases are evacuated to the Hospital of Mali (Hôpital du Mali) in Yirimadio, which is better-supplied than the CSREF and where we ultimately plan to train all staff members who are in the operating rooms [on the use of the garment]. The busiest period for OH cases usually occurs between the months of September to October. There are no epidemiological studies to date for the actual explanation of this fact, but it is a pathology finding that we have been recording for years.

Our first success with the application of the NASG occurred when we were in the middle of training on the use of the garment: a woman arrived at the center in a state of shock with only four grams of hemoglobin (blood level), while the normal level for pregnant women is 12 grams. The normal procedure would be to put her to sleep and perform aspiration, but this was not possible because she had practically run out of blood. Usually, we would have evacuated her to the national hospital, but I had to make a quick medical decision because there was a risk this woman would die on the way due to the possibility that she would have continued to lose blood. It was good timing, if you can call it that, because the alternative was to apply the NASG in order to stabilize her and proceed with a blood transfusion. This is how she was saved. So often, with the agreement of the team, these are decisions that have to be made and applied in a matter of seconds to save a life.

There are cases in which the NASG cannot be applied for now, which has made the amount of uses per week low at this stage. For instance, when patients experience acute hemorrhage, they must be directly evacuated to the hospital because not all members of our team have been trained yet for the use of the shockproof vest, therefore we cannot use the garment on these patients. In emergency situations like this, care decisions must still meet our current procedural standards.

I'll give you an example: when a woman experiences a retroplacental hematoma (premature detachment of a placenta when the woman is pregnant or in labor), there is a clot that forms between the placenta and the baby that causes extensive bleeding (OH), which can continue even after delivery. In most cases, this is caused by the coagulation of the high blood pressure associated with the pregnancy, so there is a good chance that she will be admitted to the intensive care unit. In this scenario, the patient cannot be kept at the CSREF and should be systematically evacuated to the hospital because this case can lead to serious complications. In the coming days the paramedics will also be trained on the application of the garment, which will ensure the early stabilization of the patient with the help of the NASG as they are being transported.

Overall, each time the garment was used, the situation was managed without loss of life, so it is safe to say that the garment is very important and participates in reducing the maternal mortality rate in our center.