Mrs AT, a 27 year old lady in Ndobo, Cameroon came to the GOD’s Foundation in labour. Understandably exhausted, she laid down to be examined by our colleague Dr Moses. Although she had done well reaching 7cm, Dr Moses was slightly concerned - during his examination, a brisk gush of dark blood was noticed, which is normally the sign of a placental abruption. However, the bleeding stopped and the fetal heart rate was good during the rest of her labor. Mrs AT safely delivered around three hours later with no tears. The placenta came out in one piece, but as Dr Moses suspected, there were signs that she had had a small abruption prior to labor. The uterus contracted down well but to Dr Moses, something didn’t feel right, and so he kept a close eye on her.
Dr Moses came to review her a little later, where he noticed that Mrs AT was still bleeding vaginally and her blood showed poor clotting. Calculating the blood loss revealed Mrs AT had lost over 750 mls of blood. Her pulse was weak and her blood pressure was nearly unmeasurable. Her consciousness was fading. She was in hypovolemic shock from a severe postpartum hemorrhage. She was immediately wrapped in an NASG and his team rapidly infused fluids into her whilst getting her ready for transfer to a better equipped hospital. On the way, they stopped at another hospital that had the patient’s cross matched blood, and they commenced a blood transfusion on the way to a larger hospital.
On arrival, Mrs AT was still drowsy and the emergency obstetrics team took her straight to theatre as her vitals had not shown any real improvement. Still bleeding, the team decided on a hysterectomy. At this point her hemoglobin reached an extremely low level of 4.8gm/dl. Further units were transfused as the operation went underway. By the end of surgery, she had lost a total of 3000 vmls. Despite this, immediately post-surgery, her blood pressure, pulse and urine output all showed signs of improvement. 8 days later, she was discharged home “having been raised from death or having been brought safe to life by the use of NASG” – Dr Ekiko Ekole Patrick Moses
Dr Moses shares two more cases where NASG has saved women’s lives at the brink of death. The anti shock garment applies circumferential counter pressure to decrease blood loss and reverses shock by moving blood from the peripheries to the brain, heart and lungs. A huge advantage is that It does not need to be removed for vaginal examinations as it consists of many Velcro straps applied to different parts of the body. Therefore, even in surgery for a hysterectomy, only the abdominal strap needs to be opened. In addition, application of the device is pretty self-explanatory and is rapid.
The NASG is being widely used in countries such as Kenya, Zambia, Zimbabwe, Nigeria, Bangladesh and India. However, it’s potential is not limited to developing countries. It can have huge beneficial effects in rural areas of the United States, where obstetric services are shutting down and secondary and tertiary hospitals are far away. It can also be of use in ambulances that are called to situations of obstetric hemorrhage after home births. In an obstetric hemorrhage women can lose up to 150-200 mls per minute. If nothing is done, death can occur in less than 2 hours. NASGs buy doctors time when they don’t have the time. Therefore, in areas of the world where there are delays in accessing care (regardless of whether this is in the global north or south), NASGs should be an instrumental part of the obstetric hemorrhage protocol.
Now as a next step, we ask what could be done to lower the costs of the implementation of the E-MOTIVE bundle? The most obvious answer is to consider displacing the tens of thousands of disposable plastic drapes with a purpose-built reusable device.
Fortunately one of the obstetricians involved in the E-MOTIVE study, Dr. Justus Hofmeyr, had been innovating around this very issue, designing a tray with wells that could fit under a woman’s buttocks, collect and accurately measure the. blood. This tray, theMaternaWellTraywas conceived as a device that could be sterilized and reused, and is manufactured in South Africa by Umoya.
The Pumani bubbleCPAP was designed to meet this need for Malawi and is now widely available through Maternova. We had a few questions about post-research phases of the Pumani bubbleCPAP which we posed to Jocelyn Brown, inventor of the Pumani bubbleCPAP, and Molly McCabe, Director of Product Management.