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Causes of Maternal Mortality in Japan
Ken Nagaya, MD;
Michael D. Fetters, MD, MPH, MA;
Mutsuo Ishikawa, MD;
Takahiko Kubo, MD;
Takashi Koyanagi, MD;
Yoshiharu Saito, MD;
Hiroshi Sameshima, MD;
Mitsuhiro Sugimoto, MD;
Koichiro Takagi, MD;
Yoshihide Chiba, MD;
Hiroshi Honda, MD;
Masaaki Mukubo, MD;
Mitsuhiro Kawamura, MD;
Shoji Satoh, MD;
Reiko Neki, MD
JAMA. 2000;283:2661-2667.
Context Japan's maternal mortality rate is higher than that of other developed countries.
Objectives To identify causes of maternal mortality in Japan, examine attributes of treating facilities associated with maternal mortality, and assess the preventability of such deaths.
Design and Setting Cross-sectional study of maternal deaths occurring in Japan between January 1, 1991, and December 31, 1992.
Subjects Of 230 women who died while pregnant or within 42 days of being pregnant, 197 died in a hospital and had medical records available, 22 died outside of a medical facility, and 11 did not have records available.
Main Outcome Measures Maternal mortality rates per 100,000 live births by cause (identified by death certificate review and information from treating physicians or coroners); resources and staffing patterns of facilities where deaths occurred; and preventability of death, as determined by a 42-member panel of medical specialists.
Results Overall maternal mortality was 9.5 per 100,000 births. Hemorrhage was the most common cause of death, occurring in 86 (39%) of 219 women. Seventy-two (37%) of 197 deaths occurring in facilities were deemed preventable and another 32 (16%) possibly preventable. Among deaths that occurred in a medical facility with an obstetrician on duty, the highest rate of preventable deaths (4.09/100,000 live births) occurred in facilities with 1 obstetrician. Among the 72 preventable deaths, 49 were attributed to 1 physician functioning as the obstetrician and anesthetist. While the unpreventable maternal death rate was highest in referral facilities, the preventable maternal death rate was 14 times lower in referral facilities than in transferring facilities.
Conclusions Inadequate obstetric services are associated with maternal mortality in Japan. Reducing single-obstetrician only delivery patterns and establishing regional 24-hour inpatient obstetrics facilities for high-risk cases may reduce maternal mortality in Japan.
Author Affiliations: Sayama Health Center, Sayama, Saitama, Japan (Dr Nagaya); Department of Family Medicine, University of Michigan Health System, Ann Arbor (Dr Fetters); Department of Obstetrics and Gynecology, Asahikawa Medical College, Asahikawa, Hokkaido (Drs Ishikawa and Kawamura); Maternity and Perinatal Intensive Care Unit, Kochi Medical School, Nangoku (Dr Kubo); Maternity and Perinatal Care Unit, Kyushu University Hospital, Fukuoka, Fukuoka (Drs Koyanagi and Satoh); Department of Obstetrics and Gynecology, Hirosaki University School of Medicine, Hirosaki, Aomori (Dr Saito); Perinatal Center and Department of Obstetrics and Gynecology, Miyazaki Medical College, Kiyotake, Miyazaki (Dr Sameshima); Department of Obstetrics and Gynecology, Japanese Red Cross Medical Center, Tokyo (Dr Sugimoto); Department of Obstetrics and Gynecology, Daini Hospital, Tokyo Women's Medical College (Dr Takagi); Department of Perinatology, National Cardiovascular Center, Saita, Osaka (Drs Chiba and Neki); Department of Obstetrics and Gynecology, Mitsui Memorial Hospital, Tokyo (Dr Honda); and Department of Obstetrics and Gynecology, Yodogawa Christian Hospital, Osaka (Dr Mukubo), Japan.
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