title: Causes of maternal mortality in Japan.
abstract: BACKGROUND
  Japan's maternal mortality rate is higher than that of other developed countries.
  
  
  OBJECTIVE
  To identify causes of maternal mortality in Japan, examine attributes of treating facilities associated with maternal mortality, and assess the preventability of such deaths.
  
  
  METHODS
  Cross-sectional study of maternal deaths occurring in Japan between January 1, 1991, and December 31, 1992.
  
  
  METHODS
  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.
  
  
  METHODS
  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. JAMA. 2000;283:2661-2667.
authors.affiliation: Sayama Health Center, 2-16-1, Inariyama, Sayama, Saitama, 350-1324, Japan. NagayaKen@aol.com
authors.forename: K
authors.initials: K
authors.lastname: Nagaya
authors.forename: M D
authors.initials: MD
authors.lastname: Fetters
authors.forename: M
authors.initials: M
authors.lastname: Ishikawa
authors.forename: T
authors.initials: T
authors.lastname: Kubo
authors.forename: T
authors.initials: T
authors.lastname: Koyanagi
authors.forename: Y
authors.initials: Y
authors.lastname: Saito
authors.forename: H
authors.initials: H
authors.lastname: Sameshima
authors.forename: M
authors.initials: M
authors.lastname: Sugimoto
authors.forename: K
authors.initials: K
authors.lastname: Takagi
authors.forename: Y
authors.initials: Y
authors.lastname: Chiba
authors.forename: H
authors.initials: H
authors.lastname: Honda
authors.forename: M
authors.initials: M
authors.lastname: Mukubo
authors.forename: M
authors.initials: M
authors.lastname: Kawamura
authors.forename: S
authors.initials: S
authors.lastname: Satoh
authors.forename: R
authors.initials: R
authors.lastname: Neki
mesh_terms: D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008428:Maternal Mortality / Q000639:trends*; D008875:Middle Aged; D009774:Obstetrics / Q000706:statistics & numerical data; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality* / Q000517:prevention & control