Context Japan's maternal mortality rate is higher than that of other developed
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.