Aortic Compression Trial (ACT) - a randomized controlled trial to reduce blood loss at cesarean section

Purpose: To reduce severe postpartum hemorrhage (PPH), causing maternal morbidity and mortality worldwide. Aim: To assess if manual external aortic compression is effective and safe to prevent severe PPH in cesarean section. Severe PPH is maternal blood loss >1000 ml at childbirth, more common in cesarean (14%) than vaginal births (7%).

External aortic compression is used to temporize heavy blood loss, however never tested as a preventive method.

A Cochrane review stated in 2020 that mechanical methods for the prevention and treatment of PPH, including aortic compression, urgently need scientific evaluation.

We will assess the efficacy and safety of manual external aortic compression in a multicenter superiority randomized controlled trial including 2246 patients over three years. Population: Patients undergoing planned cesarean section. Intervention: Preventive manual external aortic compression. Control: No preventive aortic compression (standard care).

Outcomes: Primary: Calculated blood loss >1000 ml or blood transfusion within 48 hours (binary).

Secondary: gravimetric blood loss, maternal and neonatal morbidity and death, use of uterotonics and treatment for bleeding, transfer to higher level care, women´s sense of wellbeing, acceptability and satisfaction with the intervention, breastfeeding, and adverse effects.

Direct patient benefits include reduced morbidity and mortality from severe PPH worldwide, using a simple, low-cost, and well-known method in a new way.