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| Training CPR on newborn manikin |
Where most mothers deliver at home (80% in Cambodia, 90% in rural Afghanistan) damage control must start at village level. That means that we have to break the hospitals’ traditional privilege of live-saving interventions, and delegate certain life-saving skills to non-doctors at health centers and to lay persons at village level. Since 2005 TCF with Cambodian health authorities are running a prospective clinical study of Delivery Life Support in the mine belts in rural Northwestern Cambodia aiming at a 50% reduction of MMR and PMR. Results are pending.
This is Delivery Life Support
At village level: compression of abdominal aorta.
The main reason for post-partum bleeding is atonic uterus that does not contract. Bleeding is reduced by external manual compression of the abdominal aorta at the level of umbilicus. This damage control technique is also useful in retroperitoneal bleeding from pelvic fractures.
At health center: Intra-uterine condom tampon.
Where uterus still does not contract on misoprostol treatment, uterine bleeding is efficiently controlled by a condom tampon of 4 – 500 ml fluid.
At district hospital: B-Lynch suture
This is a compression suture for flaccid and atonic uterus. B-Lynch suture and ligature of uterine artery is trained on animals under anesthesia.