Helping Mothers Survive
Bleeding after Birth Complete Day 1
OSCE 7: Non-pneumatic anti-shock garment (NASG)
Guidelines to be read to participants:
• For each station assume you are in a rural health care facility with no surgical or blood
transfusion capacity. You do have all equipment and supplies necessary for a normal
vaginal birth and for basic emergency management.
• All essential information will be provided to you at the start of each OSCE station.
• Ask the evaluator to clarify any questions prior to beginning. Once the OSCE has started,
the evaluator will only provide information about the patient status.
• You will have 4 minutes to complete each station.
• Talk to and care for the woman in front of you exactly as you would in real life. Do
NOT talk to me as an examiner!
• Be explicit in verbalizing your clinical thinking and subsequent decisions.
• If you give a medication, you must state what you are giving, the dose, the route, and
why you are giving it.
NASG – Skill Check
Instructions for the examiner
• Briefly review the instructions for the participant.
• Start with an “expert client” or facilitator prepared to enact woman in shock and wear NASG.
• Observe only; do not intervene in demonstration of the participant.
• In the items below you will see instructions to you in italics. Follow these instructions.
• If an item has more than one component, all components must be done to earn a “Yes”.
• The feedback will be held at the end of the assessment for all learners.
Read the following to the learner: “An ambulance arrives carrying a woman who is bleeding heavily after a
home delivery. She has just endured an hour-long journey to the facility. By the time the woman arrives, you
suspect she is in shock. The cloth beneath her is soaked with blood, and she is confused and disoriented. You
quickly check her pulse which is 120 beats/min and her BP which is 86/52. You check her uterine tone and find
her uterus is not contracted. You called for help and quickly give 10 IU oxytocin IM. The nurse brings you the
NASG for you to apply while she gathers IV supplies. Please put the NASG on this woman.”
Key
Pass score for NASG = 10/13
Helping Mothers Survive: Bleeding after Birth Complete, Training Package, created by Jhpiego (08/2017)
Helping Mothers Survive: Bleeding after Birth Complete
OSCE 7: Non-pneumatic anti-shock garment (NASG)
Participant name or ID# Date
Checklist of skills Yes No
Did NOT
Performed perform to
to standard standard
Check appropriate box for each
item
1.1 Explains what learner is about to do and why to client to
demonstrate respectful care.
1.2 Places woman correctly on open NASG. (Proper positioning means
that top of NASG segments is at lowest rib, and pressure ball is over
umbilicus.)
1.3 Closes ankle segment pair.
1.4 Checks if the NASG is tight enough by placing 1-2 fingers under top
of NASG segment, pulling back the fabric and letting it go. (When
segment is tight enough, it sounds like snapping fingers.)
1.5 Continues to close segment pairs from segment 2 and to segment 6
over umbilicus with pressure ball over umbilicus.
1.6 Checks tightness with snapping sound after closing each segment.
1.7 Ensures woman can breathe normally (observes breathing and
verbalizes what she is doing. If breathing is strained, loosens NASG
at 5th and 6th segments).
1.8 Ask: “Now that NASG is applied, what will you do?”
Answer: 1) continue to manage client for atonic uterus by
massaging uterus and starting IV fluids & uterotonics 2) monitor for
shortness of breath and decreased urine output.
1.9 Ask: “When is it safe to remove NASG?”
Answer: When for at least 2 hours:
• Pulse is 100 bpm or less
• sBP is 100 mmHg or higher
• Bleeding is at normal postpartum rate
1.10 Ask: “Please remove NASG and describe how/when you would do
each step”
Starts with ankle segment pair
1.11 Says that s/he will wait 15 minutes and retake pulse and BP. States
if pulse does not increase more than 20 beats per minute, and sBP
does not decrease more than 20 mmHg, will continue opening the
next segment pair. (must give all portions of this answer to be
correct)
1.12 Opens remaining segment pairs, verbalizing that he/she will wait 15
minutes between each, and check pulse and BP before continuing.
1.13 Ask: “What will you do if sBP drops by more than 20mmHG or pulse
> by more than 20 bpm?”
Answer: s/he will 1) rapidly reclose the NASG and 2) look for the
source of bleeding.
Score /13 Pass / Fail (circle one)
Helping Mothers Survive: Bleeding after Birth Complete, Training Package, created by Jhpiego (08/2017)
