External aortic compression device: the first aid for postpartum hemorrhage control

Abstract

Aim: To evaluate the external aortic compression device (EACD) as a first aid to control postpartum hemorrhage (PPH).

Methods: Three hundred women whose deliveries were complicated with PPH were recruited into a quasi-randomization study. Groups comprised 120 women each who had atonic PPH. The EACD was used together with traditional management in study women, while traditional management alone was used in control women. Outcome measures were maternal mortality, morbidity (hysterectomy), amount of blood transfusion (BT), uterotonic drugs and time to stop bleeding. Side effects of the EACD were assessed. Atonic PPH was defined as a blood loss of >or=500 mL from an atonic uterus with circulatory compromise within 24 hrs of childbirth. Controls were treated with i.v. access, nasal oxygen, fresh BT, uterine massage, El-Menia air inflated balloon and uterotonic drugs. Study women were treated using EACD together with conventional management.

Results: Time to stop bleeding was significantly shorter (36.8 +/- 23.4 vs 118.6 +/- 36.8 min) in study women than in control women (P < 0.001); 87.5% of study women, but no single woman in the control group had their bleeding stopped within the first 45 min of PPH onset. No morbidities or mortality among those who received EACD compared with control women, among who had five surgical hysterectomies and one mortality. The amount of BT units (302 vs 200), ergometrine ampoules (3.6 +/- 0.5 vs 2.5 +/- 0.8), syntocinon units (30.6 +/- 0.5 vs 20.5 +/- 0.8) and misoprostol tablets (6.7 +/- 1.8 vs 3.8 +/- 0.7) received were significantly more in the control group than in the study group (P < 0.001). Adverse effects of EACD were rarely observed.

Conclusion: EACD is a cost-effective and easily applied maneuver that allows satisfactory management of PPH without maternal mortality or morbidity. It is of value in developing countries.