1. Prevention and Management of PPH: Utilizing Uterotonics and the Non-Pneumatic Anti-Shock Garment (NASG) Dr. Abdelhadi Eltahir, Sr. Advisor for Maternal and Newborn Health CORE Group Spring Meeting EQUITY IN HEALTH: ENSURING ACCESS, INCREASING USE Radisson Hotel, Baltimore May 9 to 13, 2011

4. Expanding clinical staff capacity to improve quality of services

7. Induce or augment labor by;

8. Increasing frequency of contractions during labor,

9. Increasing intensity of contractions during labor, and

11. Ergometrine or syntometrine

12. MisoprostolInjectable uterotonic drugs are administered IM or IV Tablet uterotonics are given orally, vaginally or rectally (for PPH)

13. Retaining effectiveness and potency UTEROTONICS SHOCK & NASG OUR WORK OVERVIEW Source: WHO, USAID, POPPHI

14. UTEROTONICS SHOCK & NASG OUR WORK OVERVIEW Shift to best practice in use of uterotonics: Oxytocin Oxytocin is the drug of choice for AMTSL Administering oxytocin immediately after childbirth has led to significant impact in preventing and reducing PPH Demand remains high for AMTSL

15. UTEROTONICS SHOCK & NASG OUR WORK OVERVIEW Addressing Hypovolemic Shock: How the non-pneumatic anti-shock garment (NASG) works

16. UTEROTONICS SHOCK & NASG OUR WORK OVERVIEW The non-pneumatic anti-shock garment (NASG) The NASG shunts blood accumulating in the lower extremities back up to the vital organs, including the brain, heart, and lungs Women in shock are placed in the garment to temporarily stabilize them during transportation or while waiting for surgery / other treatment It is made of neoprene and Velcro, with a firm ball at the abdomen which compresses the uterus to decrease bleeding It can be used at all levels of health facilities (public and private) and in ambulances

17. UTEROTONICS SHOCK & NASG OUR WORK OVERVIEW Hypovolemic shock and how the NASG works Severe bleeding deprives vital organs of oxygen as blood accumulates in the lower body The NASG reverses shock by shunting blood from the lower extremities and abdomen to vital organs

18. UTEROTONICS SHOCK & NASG OUR WORK OVERVIEW CC-PPH model coverage Maternal mortality per 100,000 live births Bangladesh Peru India Tanzania Nigeria

19. UTEROTONICS SHOCK & NASG OUR WORK OVERVIEW Challenges in implementing the NASG Implementation of the garment requires frequent training and supportive supervision A danger of using the garment lies in the potential for untrained providers to remove it at the wrong time, causing rapid decompression and shock Logistic issues include getting the garment returned to it’s “home” site, properly cleaned, dried and stored, for use by the next PPH emergency case

20. Thank you! Let’s make the lives of every mother and child count!