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

The ACT trial investigates if manual external aortic compression is an effective and acceptable preventive measure to reduce severe postpartum hemorrhage (PPH) in cesarean section.Severe PPH is a maternal blood loss ≥1000 ml at childbirth. Severe PPH causes maternal mortality and morbidity. Severe PPH is more common in cesarean sections (14%) than vaginal births (7%).

Routine oxytocin injection and swift placenta delivery is recommended to prevent PPH.

Manual external aortic compression is used to temporize blood loss and can be used during cesarean section until bleeding control is attained.

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

The ACT trial is a multicenter randomized controlled trial including 630 patients in four Swedish regions running over two years. The trial includes patients undergoing cesarean section.

The intervention is routine manual external aortic compression and the comparison is no routine external aortic compression. The primary outcome is proportion of patients with ≥1000 ml blood loss within 24 hours from childbirth.

Secondary outcomes are mortality, serious morbidity, blood transfusion, operation duration, patient experience, and postnatal health.If proven effective and acceptable, external aortic compression is a simple and low-cost measure that could reduce severe PPH and improve childbirth care worldwide.