Non-Pneumatic Anti-Shock Garment for Obstetrical Hemorrhage: Zambia and Zimbabwe

NCT ID: NCT00488462

Last Updated: 2015-01-21

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

887 participants

Study Classification

INTERVENTIONAL

Study Start Date

2007-10-31

Study Completion Date

2012-05-31

Brief Summary

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This trial will address the question of whether early application of the Non-pneumatic Anti-Shock Garment (NASG) at the Satellite Health Facility (SHF) level before transport to a Referral Hospital (RH) will decrease maternal mortality and morbidity. The available evidence indicates that the NASG substantially decreases blood loss, but there is no evidence that its application will reduce extreme adverse outcomes. It is also not known if possible side effects associated with NASG use might outweigh potential benefits. This study would rigorously test the effectiveness of the NASG using an experimental design with adequate power to detect statistically significant decreases in morbidity and mortality.

Detailed Description

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This study is a cluster randomized controlled trial to examine the effects of NASG application as a first-aid device at the SHFs before transfer to Referral Hospitals (RHs).

The first step will include start-up activities and formative data collection, including facility staff training in data collection, how to collect blood in the closed-end blood collection drape, and in an evidence-based standardized clinical protocol for obstetric hemorrhage prevention and hemorrhage and shock management. Next will be a period of baseline data collection at the RHs and SHFs, during which clinical and demographic data will be collected from women diagnosed with obstetric hemorrhage and shock. After this baseline data collection period, we will introduce the study intervention, initially at the RHs and then at SHFs.

The intervention will include: review of study protocol differences between baseline and the NASG-intervention phases, provision of the NASG, detailed training on the use of NASG for health care providers and staff, as well as on-site support and supervision for use of the NASG. After the RH providers are fully trained and have become proficient in NASG use, SHFs will be randomized into 19 intervention and 19 control facilities. Intervention SHFs will receive the NASG training described above, while control SHFs will receive a refresher training on the topics included in the baseline training.

The final step will be three years of NASG-intervention data collection at the RHs and the SHFs on women diagnosed with obstetric hemorrhage and shock on the same outcomes collected in the baseline period. A total of approximately 2,340 women from the SHFs will be included in the NASG-intervention data collection phase of the cluster randomized trial: 1,170 women in the intervention group and 1,170 women in the control group.

Conditions

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Hypovolemic Shock Hemorrhage

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Control

Clinics will collect data on patients experiencing shock due to obstetrical hemorrhage. In the control arm, half of the study clinics will not use the NASG but the NASG will be available at the referral hospital for patients transported there.

Group Type NO_INTERVENTION

No interventions assigned to this group

Intervention

Clinics will collect data on patients experiencing shock due to obstetrical hemorrhage. In the intervention arm, half of the study clinics will use the NASG on patients before transporting to the referral hospital.

Group Type OTHER

non-pneumatic anti-shock garment

Intervention Type DEVICE

In the intervention arm, half of the study clinics will use the NASG when a patient meets the study criteria.

Interventions

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non-pneumatic anti-shock garment

In the intervention arm, half of the study clinics will use the NASG when a patient meets the study criteria.

Intervention Type DEVICE

Other Intervention Names

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NASG Anti-Shock Garment Manufactured by Zoex Life Wrap

Eligibility Criteria

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Inclusion Criteria

* Women who are pregnant or postpartum and experiencing obstetric hemorrhage with 2 of the following 3:

blood loss \> 500 mL (at SHF, 1000 mL at RH) SBP \<100 mm Hg pulse \>100 bpm

Exclusion Criteria

Women suffering obstetric hemorrhage and hypovolemic shock who have no detectable vital signs (non palpable pulse and BP) at the time of their arrival at the RH are ineligible for enrolment in the study ("non-resuscitable") if: 1) the woman does not respond to resuscitation attempts after 30 minutes and 2) more than three hours have elapsed between the start of hemorrhage and the beginning of her treatment. (As this is a clinical intervention of a potentially life saving device, the study clinicians should try the NASG on any patient if they feel it may resuscitate her; however, if the woman meets the criteria above they are ineligible for having their data entered into the study.)
Minimum Eligible Age

15 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

NIH

Sponsor Role collaborator

Bill and Melinda Gates Foundation

OTHER

Sponsor Role collaborator

University of Zambia

OTHER

Sponsor Role collaborator

University of Zimbabwe

OTHER

Sponsor Role collaborator

World Health Organization

OTHER

Sponsor Role collaborator

University of California, San Francisco

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Suellen Miller, CNM, PhD

Role: PRINCIPAL_INVESTIGATOR

University of California, San Francisco

Elizabeth Butrick, MPH, MSW

Role: STUDY_DIRECTOR

University of California, San Francisco

Thulani Magwali, OBGYN

Role: PRINCIPAL_INVESTIGATOR

University of Zimbabwe Hospital, Harare, Zimbabwe (UZ)

Gricelia Mkumba, OBGYN

Role: PRINCIPAL_INVESTIGATOR

University Teaching Hospital, Lusaka Zambia (UTH)

Locations

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Kitwe Central Hospital

Kitwe, Copperbelt, Zambia

Site Status

Ndola Central Hospital

Ndola, Copperbelt, Zambia

Site Status

University Teaching Hospital (UTH)

Lusaka, , Zambia

Site Status

Harare Hospital

Harare, , Zimbabwe

Site Status

Parienyatwa Group of Hospitals

Harare, , Zimbabwe

Site Status

Countries

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Zambia Zimbabwe

References

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Miller S, Hamza S, Bray EH, Lester F, Nada K, Gibson R, Fathalla M, Mourad M, Fathy A, Turan JM, Dau KQ, Nasshar I, Elshair I, Hensleigh P. First aid for obstetric haemorrhage: the pilot study of the non-pneumatic anti-shock garment in Egypt. BJOG. 2006 Apr;113(4):424-9. doi: 10.1111/j.1471-0528.2006.00873.x.

Reference Type BACKGROUND
PMID: 16553654 (View on PubMed)

Brees C, Hensleigh PA, Miller S, Pelligra R. A non-inflatable anti-shock garment for obstetric hemorrhage. Int J Gynaecol Obstet. 2004 Nov;87(2):119-24. doi: 10.1016/j.ijgo.2004.07.014.

Reference Type BACKGROUND
PMID: 15491555 (View on PubMed)

Miller S, Hensleigh P. Non-pneumatic Anti-shock Garment for Obstetric Hemorrhage. Chapter 14 in: (eds) B-Lynch, C, Keith, L, LaLonde, A, Karoshi, M. An International Federation of Obstetrics and Gynecology (FIGO) Book Postpartum Hemorrhage: New Thoughts, New Approaches. London, UK: Sapiens Publications; 2006. p. 136-46.

Reference Type BACKGROUND

Miller S, Ojengbede A, Turan JM, Ojengbede O, Butrick E, Hensleigh P. Anti-Shock Garments for Obstetric Hemorrhage. Current Women's Health Reviews. 2007;3(1):3-11.

Reference Type BACKGROUND

Miller S, Turan JM, Dau K, Fathalla M, Mourad M, Sutherland T, Hamza S, Lester F, Gibson EB, Gipson R, Nada K, Hensleigh P. Use of the non-pneumatic anti-shock garment (NASG) to reduce blood loss and time to recovery from shock for women with obstetric haemorrhage in Egypt. Glob Public Health. 2007;2(2):110-24. doi: 10.1080/17441690601012536.

Reference Type BACKGROUND
PMID: 19280394 (View on PubMed)

Miller S, Turan JM, Ojengbede A, Ojengbede O, Fathalla M, Morhason-Bello IO, Youssif MM, Galandanci H, Hamza S, Awwal M, Akinwuntan A, Mohammed AI, McDonough L, Dau K, Butrick E, Hensleigh P. The pilot study of the non-pneumatic anti-shock garment (NASG) in women with severe obstetric hemorrhage: Combined results from Egypt and Nigeria. Int J Gynaecol Obstet. 2006 Nov;94 Suppl 2:S154-S156. doi: 10.1016/S0020-7292(06)60022-2. No abstract available.

Reference Type BACKGROUND
PMID: 29644686 (View on PubMed)

Miller S, Martin HB, Morris JL. Anti-shock garment in postpartum haemorrhage. Best Pract Res Clin Obstet Gynaecol. 2008 Dec;22(6):1057-74. doi: 10.1016/j.bpobgyn.2008.08.008. Epub 2008 Sep 20.

Reference Type BACKGROUND
PMID: 18805742 (View on PubMed)

Miller S, Ojengbede O, Turan JM, Morhason-Bello IO, Martin HB, Nsima D. A comparative study of the non-pneumatic anti-shock garment for the treatment of obstetric hemorrhage in Nigeria. Int J Gynaecol Obstet. 2009 Nov;107(2):121-5. doi: 10.1016/j.ijgo.2009.06.005. Epub 2009 Jul 22.

Reference Type BACKGROUND
PMID: 19628207 (View on PubMed)

Miller S, Fathalla MM, Youssif MM, Turan J, Camlin C, Al-Hussaini TK, Butrick E, Meyer C. A comparative study of the non-pneumatic anti-shock garment for the treatment of obstetric hemorrhage in Egypt. Int J Gynaecol Obstet. 2010 Apr;109(1):20-4. doi: 10.1016/j.ijgo.2009.11.016. Epub 2010 Jan 22.

Reference Type BACKGROUND
PMID: 20096836 (View on PubMed)

Mourad-Youssif M, Ojengbede OA, Meyer CD, Fathalla M, Morhason-Bello IO, Galadanci H, Camlin C, Nsima D, Al Hussaini T, Butrick E, Miller S. Can the Non-pneumatic Anti-Shock Garment (NASG) reduce adverse maternal outcomes from postpartum hemorrhage? Evidence from Egypt and Nigeria. Reprod Health. 2010 Sep 1;7:24. doi: 10.1186/1742-4755-7-24.

Reference Type BACKGROUND
PMID: 20809942 (View on PubMed)

Miller S, Fathalla MM, Ojengbede OA, Camlin C, Mourad-Youssif M, Morhason-Bello IO, Galadanci H, Nsima D, Butrick E, Al Hussaini T, Turan J, Meyer C, Martin H, Mohammed AI. Obstetric hemorrhage and shock management: using the low technology Non-pneumatic Anti-Shock Garment in Nigerian and Egyptian tertiary care facilities. BMC Pregnancy Childbirth. 2010 Oct 18;10:64. doi: 10.1186/1471-2393-10-64.

Reference Type BACKGROUND
PMID: 20955600 (View on PubMed)

Ojengbede OA, Morhason-Bello IO, Galadanci H, Meyer C, Nsima D, Camlin C, Butrick E, Miller S. Assessing the role of the non-pneumatic anti-shock garment in reducing mortality from postpartum hemorrhage in Nigeria. Gynecol Obstet Invest. 2011;71(1):66-72. doi: 10.1159/000316053. Epub 2010 Dec 15.

Reference Type BACKGROUND
PMID: 21160197 (View on PubMed)

Turan J, Ojengbede O, Fathalla M, Mourad-Youssif M, Morhason-Bello IO, Nsima D, Morris J, Butrick E, Martin H, Camlin C, Miller S. Positive effects of the non-pneumatic anti-shock garment on delays in accessing care for postpartum and postabortion hemorrhage in Egypt and Nigeria. J Womens Health (Larchmt). 2011 Jan;20(1):91-8. doi: 10.1089/jwh.2010.2081. Epub 2010 Dec 29.

Reference Type BACKGROUND
PMID: 21190486 (View on PubMed)

Fathalla MM, Youssif MM, Meyer C, Camlin C, Turan J, Morris J, Butrick E, Miller S. Nonatonic obstetric haemorrhage: effectiveness of the nonpneumatic antishock garment in egypt. ISRN Obstet Gynecol. 2011;2011:179349. doi: 10.5402/2011/179349. Epub 2011 Aug 10.

Reference Type BACKGROUND
PMID: 21845226 (View on PubMed)

Morris, J., Meyer, C., Fathalla, MF, Youssif, MM, Al-Hussaini, TK, Camlin, C., Miller, S. Treating Uterine Atony with the NASG in Egypt. African Journal of Midwifery and Women's Health 5(1):37-42, 2011

Reference Type BACKGROUND

Ojengbede, O., Galadanci, H., Morhason-Bello, IO, Nsima, D., Camlin, C., Morris, J., Butrick, E., Meyer, C., Mohammed, AI, Miller, S. The Non-pneumatic Anti-Shock Garment for Postpartum Haemorrhage in Nigeria. African Journal of Midwifery and Women's Health 5(3):135-9, 2011

Reference Type BACKGROUND

Lester F, Stenson A, Meyer C, Morris J, Vargas J, Miller S. Impact of the Non-pneumatic Antishock Garment on pelvic blood flow in healthy postpartum women. Am J Obstet Gynecol. 2011 May;204(5):409.e1-5. doi: 10.1016/j.ajog.2010.12.054. Epub 2011 Mar 24.

Reference Type BACKGROUND
PMID: 21439543 (View on PubMed)

Stenson, A., Lester, F., Meyer, C., Morris, J., Vargas, V., Miller, S. The Non-pneumatic Anti-Shock Garment: How Applier Strength and Body Mass Index Affect Pressure. International Journal of Gynecology and Obstetrics, 2011; 5:33-37

Reference Type BACKGROUND

Kausar F, Morris JL, Fathalla M, Ojengbede O, Fabamwo A, Mourad-Youssif M, Morhason-Bello IO, Galadanci H, Nsima D, Butrick E, Miller S. Nurses in low resource settings save mothers' lives with non-pneumatic anti-shock garment. MCN Am J Matern Child Nurs. 2012 Sep;37(5):308-16. doi: 10.1097/NMC.0b013e318252bb7d.

Reference Type BACKGROUND
PMID: 22895203 (View on PubMed)

Miller S, Bergel EF, El Ayadi AM, Gibbons L, Butrick EA, Magwali T, Mkumba G, Kaseba C, Huong NT, Geissler JD, Merialdi M. Non-pneumatic anti-shock garment (NASG), a first-aid device to decrease maternal mortality from obstetric hemorrhage: a cluster randomized trial. PLoS One. 2013 Oct 23;8(10):e76477. doi: 10.1371/journal.pone.0076477. eCollection 2013.

Reference Type DERIVED
PMID: 24194839 (View on PubMed)

Related Links

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http://www.lifewrap.org

Information and updates on current trials using the Life Wrap (NASG) for obstetric hemorrhage in low resource settings.

Other Identifiers

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5R01HD053129-03

Identifier Type: NIH

Identifier Source: secondary_id

View Link

1R01HD053129-01A1

Identifier Type: NIH

Identifier Source: org_study_id

View Link

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