Causes of maternal mortality in Japan

Context Japan's maternal mortality rate is higher than that of other develo ped countries. Objectives To identify causes of maternal mortality in Japan, examine attri butes 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 Ja pan between January 1, 1991, and December 31, 1992, Subjects Of 230 women who died while pregnant or within 42 days of being pr egnant, 197 died in a hospital and had medical records available, 22 died o utside of a medical facility, and 11 did not have records available. Main Outcome Measures Maternal mortality rates per 100000 live births by ca use (identified by death certificate review and information from treating p hysicians 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 100000 births. Hemorrhage wa s the most common cause of death, occurring in 86 (39%) of 219 women. Seven ty-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 preventa ble deaths (4.09/100000 live births) occurred in facilities with 1 obstetri cian. Among the 72 preventable deaths, 49 were attributed to 1 physician fu nctioning as the obstetrician and anesthetist. While the unpreventable mate rnal death rate was highest in referral facilities, the preventable materna l death rate was 14 times lower in referral facilities than in transferring facilities. Conclusions Inadequate obstetric services are associated with maternal mort ality in Japan. Reducing single-obstetrician only delivery patterns and est ablishing regional 24-hour inpatient obstetrics facilities for high-risk ca ses may reduce maternal mortality in Japan.