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Войти в исследования International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026
Effects of descending aortic occlusion for massive obstetric hemorrhage: Nationwide analysis of maternal death in Japan.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Aoki Makoto, Obata Soichiro, Ogoyama Manabu, Shimura Koki, Iwagoi Yutaka, Kasahara Makiko, Yoshida Yui, Yamashita Saya, Sekizawa Akihiko, Hashii Koji, Nakata Masahiko, Murakoshi Takeshi, Katsuragi Shinji, Tanaka Hiroaki, Tanaka Kayo, Sagara Yoko, Arakaki Tatsuya, Hasegawa Junichi, Working group of Maternal Mortality 2025 in the Japan Association of Obstetricians and Gynecologists
Аннотация
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.
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.