Temporary aortic occlusion with the abdominal tourniquet for refractory postpartum hemorrhage: A proof-of-concept study in a war-affected region

Abstract

Objective: To evaluate the feasibility and preliminary clinical efficacy of the abdominal aortic tourniquet as a temporary intervention for managing severe postpartum hemorrhage (PPH) resulting from uterine atony in a war-affected region.

Methods: This prospective, open-label, non-randomized, proof-of-concept study was performed at Olexandrivska Hospital, Zaporizhzhia, Ukraine from December 2024 to April 2025. Four women (≥18 years) with primary PPH (>1000 mL blood loss) unresponsive to standard management (uterotonics, balloon tamponade) were included. The abdominal aortic tourniquet was applied, achieving temporary aortic occlusion by inflating it to 250 mm Hg pressure for a duration of up to 45 min. Clinical outcomes, feasibility, and safety parameters were assessed.

Results: In all cases, external bleeding was effectively controlled within 2 min of tourniquet inflation. This provided critical time for mobilizing the surgical team, preparing the operating theater, administering anesthesia, and delivering blood products. The device remained in place during a mean period of 38.8 min (range 30-45 min). After achieving adequate anesthesia and availability of resources, the device was deflated under observation. In three patients (75%), bleeding resumed upon release of the aortic compression, prompting immediate surgical intervention. In one patient (25%), bleeding ceased spontaneously after deflation without further intervention. No device-related complications, thrombotic events, infections, or ischemic injuries were observed.

Conclusion: The abdominal aortic tourniquet was effective in temporarily controlling severe PPH in a conflict-affected, resource-limited setting. By safely bridging the critical time gap before definitive surgical management, this life-saving intervention demonstrated considerable potential for use in resource-limited and crisis settings.

Keywords: Abdominal aortic and junctional tourniquet—stabilized; Aortic compression; Postpartum hemorrhage.