Obstetric hemorrhage and shock management using the low technology Non-pneumatic Anti-Shock Garment in Nigerian and Egyptian tertiary care facilities 英文参考文献.docVIP

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Obstetric hemorrhage and shock management using the low technology Non-pneumatic Anti-Shock Garment in Nigerian and Egyptian tertiary care facilities 英文参考文献.doc

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Obstetric hemorrhage and shock management using the low technology Non-pneumatic Anti-Shock Garment in Nigerian and Egyptian tertiary care facilities 英文参考文献

Milleretal.BMCPregnancyandChildbirth2010,10:64 /1471-2393/10/64 RESEARCH ARTICLE OpenAccess Obstetrichemorrhageandshockmanagement: usingthelowtechnologyNon-pneumaticAnti- ShockGarmentinNigerianandEgyptiantertiary carefacilities SuellenMiller1*,MohamedMFFathalla2,OladosuAOjengbede3,CarolCamlin1,MohammedMourad-Youssif4, ImranOMorhason-Bello3,HadizaGaladanci5,DavidNsima6,ElizabethButrick1,TarekalHussaini2,JanetTuran1, CarinneMeyer1,HilarieMartin1,AminuIMohammed 7,8 Abstract Background:Obstetrichemorrhageistheleadingcauseofmaternalmortalityglobally.TheNon-pneumaticAnti- ShockGarment(NASG)isalow-technology,first-aidcompressiondevicewhich,whenaddedtostandard hypovolemicshockprotocols,mayimproveoutcomesforwomenwithhypovolemicshocksecondarytoobstetric hemorrhageintertiaryfacilitiesinlow-resourcesettings. Methods:Thisstudyemployedapre-intervention/interventiondesigninfourfacilitiesinNigeriaandtwoinEgypt. Primaryoutcomesweremeasuredmeanandmedianbloodloss,severeend-organfailuremorbidity(renalfailure, pulmonaryfailure,cardiacfailure,orCNSdysfunctions),mortality,andemergencyhysterectomyfor1442women with≥750mLbloodlossandatleastonesignofhemodynamicinstability.Comparisonsofoutcomesbystudy phasewereassessedwithranksumtests,relativerisks(RR),numberneededtotreatforbenefit(NNTb),and multiplelogisticregression. Results:WomenintheNASGphase(n=835)wereinworseconditiononstudyentry,38.5%withmeanarterial pressure60mmHgvs.29.9%inthepre-interventionphase(p=0.001).Despitethis,negativeoutcomeswere significantlyreducedintheNASGphase:meanmeasuredbloodlossdecreasedfrom444mLto240mL(p 0.001),maternalmortalitydecreasedfrom6.3%to3.5%(RR0.56,95%CI0.35-0.89),severemorbiditiesfrom3.7%to 0.7%(RR0.20,95%CI0.08-0.50),andemergencyhysterectomyfrom8.9%to4.0%(RR0.44,0.23-0.86).Inmultiple logisticregression,therewasa55%reducedoddsofmortalityduringtheNASGphase(aOR0.45,0.27-0.77).The NNTbtopreventeithermortalityorseveremorbiditywas18(12-36). Conclusion:AddingtheNASGtostandardshockandhemorrhagemanagementmays