What is the clinical evidence from this study?

Study design: Observational. Population: Severe postpartum hemorrhage (n=109). Intervention: Aortic occlusion (REBOA and/or RT-ACC) vs. Non-aortic occlusion. Primary outcome: Achievement of definitive hemostatic procedures (p=< 0.01).

What does this research mean for the field?

Aortic occlusion is associated with significantly higher rates of definitive hemostasis and 24-hour survival compared to non-aortic occlusion in cases of severe postpartum hemorrhage. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

Evaluate the impact of aortic occlusion on severe postpartum hemorrhage and maternal mortality in Japan.

May 10, 2026

Effects of descending aortic occlusion for massive obstetric hemorrhage: Nationwide analysis of maternal death in Japan

Q: What are the key findings of this study?

Aortic occlusion was associated with significantly higher rates of definitive hemostasis (78.9% vs 42.2%, P<0.01) and 24-hour survival compared to non-aortic occlusion in severe postpartum hemorrhage.

Q: What does this research mean for the field?

Aortic occlusion is associated with significantly higher rates of definitive hemostasis and 24-hour survival compared to non-aortic occlusion in cases of severe postpartum hemorrhage. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

Evaluate the impact of aortic occlusion on severe postpartum hemorrhage and maternal mortality in Japan.

Key Result

Aortic occlusion was associated with significantly higher rates of definitive hemostasis (78.9% vs 42.2%, P<0.01) and 24-hour survival compared to non-aortic occlusion in severe postpartum hemorrhage.

Key Points

Evaluate the impact of aortic occlusion on severe postpartum hemorrhage and maternal mortality in Japan.
Nationwide retrospective observational study of maternal deaths from hemorrhage in Japan (2010-2024)
Patients classified into AO group (REBOA/RT-ACC) and non-AO group
Primary outcome: achievement of definitive hemostasis; secondary outcome: 24-hour survival rates.
In the AO group, 78.9% achieved definitive hemostasis compared to 42.2% in the non-AO group (P < 0.01)
24-hour survival was 42.1% in the AO group vs 15.6% in the non-AO group (P = 0.02)
84.2% of AO patients were transferred to tertiary care centers, compared to 43.3% in the non-AO group (P < 0.01)

Study Design

Type

Observational (n=109)

Multicenter

Yes

Structured PICO

Does aortic occlusion improve the achievement of definitive hemostatic procedures and 24-hour survival in patients with severe postpartum hemorrhage?

Population

109 hemorrhage-related maternal deaths from a nationwide maternal death registry in Japan between 2010 and 2024.

Intervention

Aortic occlusion (AO), including resuscitative endovascular balloon occlusion of the aorta (REBOA) and/or resuscitative thoracotomy with aortic cross-clamping (RT-ACC).

Comparator

Non-aortic occlusion (non-AO) group.

Outcome

Achievement of definitive hemostatic procedures.hard clinical

Aortic occlusion (REBOA or RT-ACC) is associated with higher rates of definitive hemostasis and 24-hour survival in cases of severe postpartum hemorrhage.

Main Result

Absolute Event Rate: 78.9% vs 42.2%

p-value: p=< 0.01

Abstract

OBJECTIVE: To evaluate the effects of aortic occlusion (AO) on severe postpartum hemorrhage (PPH)-a leading cause of preventable maternal mortality-using a nationwide maternal death registry in Japan. METHODS: A nationwide retrospective observational study of hemorrhage-related maternal deaths was conducted in Japan between 2010 and 2024. Patients were classified into an AO group (resuscitative endovascular balloon occlusion of the aorta REBOA and/or resuscitative thoracotomy with aortic cross-clamping RT-ACC) and a non-AO group. The primary outcome was the achievement of definitive hemostatic procedures. Secondary outcomes included 24-h survival. RESULTS: Among 109 hemorrhage-related maternal deaths, 19 patients underwent AO (13 REBOA, six RT-ACC). Patients in the AO group were more frequently transferred to tertiary care centers than those in the non-AO group (84.2% (16/19) vs 43.3% (39/90), P < 0.01). Achievement of definitive hemostasis was significantly higher in the AO group (78.9% (15/19) vs 42.2% (38/90), P < 0.01), as were 24-h survival (42.1% (8/19) vs 15.6% (14/90), P = 0.02). Approximately 90% of AO procedures (17/19) were performed at tertiary centers, and only 16% (3/19) were initiated before cardiopulmonary arrest. CONCLUSION: AO, including REBOA and RT-ACC, was associated with higher rates of hemostasis and short-term survival among cases of maternal death due to severe PPH. Earlier application of AO before cardiopulmonary arrest may be critical to improving outcomes.

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