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URC Project Introduces Innovation to Reduce Maternal Death in Cambodia

by Aida Olkkonen, Associate Director, URC’s Program Support Team
January 2, 2013

Drawing of the non-pneumatic anti-shock garment, which is used to prevent postpartum hemorrhage in women. Developed by Ralph Pelligra, MD, NASA, Ames Research Center.
Drawing of the non-pneumatic anti-shock garment, which is used to prevent postpartum hemorrhage in women. Developed by Ralph Pelligra, MD, NASA, Ames Research Center.

In early December, Dr. Jerker Liljestrand—Program Leader for Maternal and Newborn Health and Family Planning with the USAID Better Health Services (BHS) project, which URC implements in Cambodia—presented at CORE Group on Cambodia’s introduction of a new device to reduce maternal mortality: the non-pneumatic anti-shock garment (NASG). The NASG is a low-technology first-aid device used to treat severe postpartum blood and fluid loss.

Dr. Liljestrand was accompanied by Dr. Suellen Miller, Professor at the University of California San Francisco and Director of the Safe Motherhood Program at the university’s Bixby Center for Global Reproductive Health. She has been at the forefront of research to evaluate the use of NASGs for postpartum hemorrhage (PPH) in low-resource settings (see scientific publications here). Audio of Drs. Liljestrand’s and Miller’s remarks and their slides is available on the CORE Group website.

PPH remains the leading cause of maternal death. Maternal death during transport from health centers to hospitals is common, as is death from shock resulting from blood loss after arrival at the hospital. Without new interventions, this is unlikely to change, given that 70% of facility births take place at health centers, which lack the surgery and blood transfusion capacity typically found at hospitals. Recommended by the World Health Organization (WHO), the NASG is a proven intervention to prevent death between a diagnosis of PPH and hospital treatment.

The NASG is made of neoprene (a very stretchy synthetic rubber) segments that wrap around a mother’s legs, pelvis, and abdomen and that are held with Velcro straps. It reverses shock by returning blood from the legs and lower abdomen to the heart, lungs, and brain, restoring the woman's consciousness, pulse, and blood pressure.

With approval from the Cambodia National Reproductive Health Program, BHS piloted the NASG in Cambodia in 2012 in collaboration with PATH, which is scaling up NASG use in low-resource settings. BHS imported the specified neoprene material from a factory in Taiwan and procured a local tailor to replicate NASGs that are available in the US. The replication garments were sent to several sites for testing, including: PATH’s Seattle headquarters, the Bixby Center in San Francisco, and the National Maternal and Child Health Center in Phnom Penh (National Institute). The new garments are packaged to ensure that health care providers can use them quickly and with a job aid reminding them of correct use and a register sheet.

BHS is training hospital staff to use the NASG. The training builds on national protocols for the prevention and management of PPH, with the addition of and emphasis on NASG. Hospital staff training will be followed by training for health center staff to ensure the former are prepared to accept referrals from the latter.  Use of the NASG is expected to result in reduced mortality from postpartum hemorrhage and contribute to further reducing the rate of maternal deaths in Cambodia.

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