Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, 50 Beale Street, Suite 1200, San Francisco, CA 94105, USA.
BMC Pregnancy Childbirth. 2013 Nov 15;13:208. doi: 10.1186/1471-2393-13-208.
Obstetric hemorrhage is the leading cause of maternal mortality, particularly in low-resource settings where women face significant delays in accessing definitive treatment. The Non-pneumatic Anti-Shock Garment (NASG) is a first-aid device to stabilize women in hypovolemic shock secondary to obstetric hemorrhage. Prior studies on the effectiveness of the NASG have suffered from small sample sizes and insufficient statistical power. We sought to generate a summary effect estimate of this intervention by combining data from all previous quasi-experimental studies.
Five quasi-experimental studies that tested the NASG as treatment for hypovolemic shock secondary to obstetric hemorrhage at the tertiary care facility level were included in the analysis. We evaluated heterogeneity of effect across studies and calculated pooled odds ratios. We also conducted a subgroup analysis among women in the most severe condition.
Participant characteristics were similar across studies with some variation in hemorrhage etiology. Median blood loss was at least 50% lower in the intervention group than the control group. The pooled odds ratio suggested that NASG intervention was associated with a 38% significantly reduced odds of mortality among the overall sample, and a 59% significantly reduced odds of mortality among the most severe women.
The results from this combined analysis suggest that NASG intervention is associated with a reduced odds of death for women with hypovolemic shock secondary to obstetric hemorrhage. Further research should focus on application of the NASG at the community or primary health care level, and utilize a more robust methodology.
产科出血是产妇死亡的主要原因，尤其是在资源匮乏的环境中，这些地区的妇女在获得明确治疗方面存在严重的延误。非充气式抗休克服（NASG）是一种急救设备，用于稳定因产科出血导致低血容量性休克的妇女。先前关于 NASG 有效性的研究存在样本量小和统计能力不足的问题。我们试图通过合并所有先前的准实验研究的数据来生成该干预措施的综合效应估计。
纳入了五项在三级保健设施水平上测试 NASG 治疗产科出血性低血容量休克的准实验研究。我们评估了研究之间的效应异质性并计算了汇总优势比。我们还在病情最严重的女性中进行了亚组分析。
研究参与者的特征在不同研究中相似，但出血病因存在一些差异。干预组的中位失血量明显低于对照组。汇总优势比表明，NASG 干预与总体样本死亡率降低 38%显著相关，与最严重女性死亡率降低 59%显著相关。
这项综合分析的结果表明，NASG 干预与产科出血性低血容量休克妇女的死亡风险降低相关。进一步的研究应侧重于在社区或初级卫生保健水平应用 NASG，并采用更稳健的方法。
