{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T18:44:57Z","timestamp":1792176297514,"version":"4.4.0"},"reference-count":21,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the effects of aortic occlusion (AO) on severe postpartum hemorrhage (PPH)\u2014a leading cause of preventable maternal mortality\u2014using a nationwide maternal death registry in Japan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A nationwide retrospective observational study of hemorrhage\u2010related 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\u2010clamping [RT\u2010ACC]) and a non\u2010AO group. The primary outcome was the achievement of definitive hemostatic procedures. Secondary outcomes included 24\u2010h survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 109 hemorrhage\u2010related maternal deaths, 19 patients underwent AO (13\u00a0REBOA, six RT\u2010ACC). Patients in the AO group were more frequently transferred to tertiary care centers than those in the non\u2010AO group (84.2% (16\/19) vs 43.3% (39\/90),\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.01). Achievement of definitive hemostasis was significantly higher in the AO group (78.9% (15\/19) vs 42.2% (38\/90),\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.01), as were 24\u2010h survival (42.1% (8\/19)\u00a0vs 15.6% (14\/90),\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.02). Approximately 90% of AO procedures (17\/19) were performed at tertiary centers, and only 16% (3\/19) were initiated before cardiopulmonary arrest.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>AO, including REBOA and RT\u2010ACC, was associated with higher rates of hemostasis and short\u2010term survival among cases of maternal death due to severe PPH. Earlier application of AO before cardiopulmonary arrest may be critical to improving outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ijgo.71067","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T12:03:16Z","timestamp":1778241796000},"page":"693-698","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of descending aortic occlusion for massive obstetric hemorrhage: Nationwide analysis of maternal death in Japan"],"prefix":"10.1002","volume":"175","author":[{"given":"Makoto","family":"Aoki","sequence":"first","affiliation":[{"name":"Division of Traumatology National Defense Medical College Research Institute  Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soichiro","family":"Obata","sequence":"additional","affiliation":[{"name":"Perinatal Center for Maternity and Neonates Yokohama City University Medical Center  Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manabu","family":"Ogoyama","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Jichi Medical University  Tochigi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koki","family":"Shimura","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Graduate School of Medical Science Kyoto Prefectural University of Medicine  Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutaka","family":"Iwagoi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Life Sciences Kumamoto University  Kumamoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makiko","family":"Kasahara","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Shiga University of Medical Science  Shiga 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