Application of Non Pneumatic Anti- Shock Garment (NASG) in 100 patients of postpartum haemorrhage: analysis of causes, management and outcome in a tertiary centre of south Rajasthan

Abstract

Objectives: The present study was performed to assess the role of NASG (non pneumatic anti shock garment) in the management of postpartum haemorrhage.

Material and Methods: The present study is a retrospective study carried out in the department of Obstetrics & Gynaecology of a tertiary care institute of southern Rajasthan during the period of six years from July 2009 to June 2015. 100 patients of postpartum haemorrhage (PPH) with gestational age ≥28 weeks were included in the study. All the patients delivered at our institute and BMI ~18.5-24.9 kg/m2 so that NASG was meticulously applied.

Results: 100 patients of PPH were included in present study and NASG were applied to them. Age of the patients ranged from 18 to 45 years with the mean age of 25.99 years. 13% of the patients were grand multipara while 20% patients were primi and remaining 63% were multipara. The most common cause of PPH was atonic uterus (77%), of which commonest etiology was maternal anaemia (37.6%). Next common cause was trauma of genital tract (19%) out of which vaginal injuries were the most common (47.36%). Other rare causes were tissue factor (3%) and coagulopathies (1%).67% of the study participants had normal delivery while 29% patients had caesarian sections and remaining(4%) had instrumental delivery. After NASG application, 53% patients responded to medical management, 32% were managed surgically and rests 15% were stabilized by manoeuvres. 57% patients stayed for three days in the hospital while 29% stayed for five days. Only 3% patients had a hospital stay of ≥ six days.

Conclusion: The present study concluded that majority of patients suffering from PPH were multigravidas in the reproductive age group of 21-30 years. The major cause of PPH was uterine atony followed by genital tract injuries. Use of NASG in these patients significantly reduced any major surgical intervention. Most of these patients were successfully managed by uterotonics, blood components and supportive care. Even a substantial decrease in theduration of stay in hospital and ICU stay was noted.