title: PP048. Questionnaire for obstetricians and neurosurgeons on brain stroke and hypertension in pregnancy in/around Nara Prefecture, Japan.
abstract: BACKGROUND
  Brain stroke in pregnancy, one of the most emergency features in hypertensive pregnancy, was surveyed nationwide (1582 hospitals) and 184 cases (1-2 in 10000 birth) including 10 maternal deaths were reported in Japan (2006). Also in a developed country, co-work of obstetricians (OB) and neurosurgeons (NS) is not always cooperative and the situation stresses clinical workers in emergency maternal transfer.
  
  
  OBJECTIVE
  We performed a survey of obstetric and neurosurgery specialists in/around Nara Prefecture (1.3million population, placed in the middle of Japan and does not have remote rural area) about their understanding and preparation on brain stroke in pregnancy. A final aim of this study is to assess the problem in emergency care in pregnancy, especially in hypertensive disorder.
  
  
  METHODS
  Fifty-seven OB answered the first questionnaire (executed by NS [S.Y.]) in January 2011 by post. After the analysis, a new questionnaire was executed by OB (K.N.) and 70 answers were given by NS in October 2011. Items in the questionnaire are shown below. Agreements for use of the answers in this research were given by each respondent.
  
  
  RESULTS
  [Experience] Three OB (5.3%) and 32 NS (45.7%, 38 cases) experienced a brain stroke in pregnancy in their career. Four NS (10.5% of cases) faced maternal death, including brain hemorrhage after eclampsia. [Diagnosis] Symptoms that OB suspect of brain stroke were loss of consciousness > hemiplegia > headache, and hemiplegia > loss of consciousness > speech disorder in NS. [Hypertension and Brain Stroke] Sixty-four (92.8%) NS thought chronic hypertension as a risk factor of brain stroke in women in reproductive age, and 53 (75.7%) NS thought acute hypertension is. The target blood pressure in the treatment of brain stroke mostly indicated by NS was 140mm/Hg in systolic and 85mm/Hg in diastolic blood pressure. Medication for hypertension chosen by NS was calcium blocker (77.1%) and ARB (38.6%). [Emergency Transfer in Japan] In Japan, ER center to accept women with perinatal emergency is not enough stated. Once the transfer to the central hospital due to brain stroke in pregnancy is needed, a primary department to accept the patient must be decided. Forty-seven (82.7%) OB preferred the Obstetrics Department to be a primary receiver; on the other hand, 38 (56.7%) NS preferred the Neurosurgery Department and only 17 (25.3%) NS answered that obstetrics should be a primary department. Twelve (17.9%) NS answered that the both departments should work together from the beginning.
  
  
  CONCLUSIONS
  Japanese maternal mortality rate is one of the lowest in the world (3.1 per 100,000 birth; 2007), but it was revealed in this study that the maternal emergency system in pregnancy-unrelated disease is not well arranged. Even though emergency system varies between each country, this knowledge in confliction between OB and NS in this area may be useful when other countries need to maintain the ER performance in hypertensive disorder in pregnancy.
authors.affiliation: Obstetrics & Gynecology, Nara Medical University, Kashihara, Nara, Japan; Commission for Brain Stroke, Japan Society for the Study of Hypertension in Pregnancy, Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Naruse
authors.affiliation: Neurosurgery, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Yamada
authors.affiliation: Obstetrics & Gynecology, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Noguchi
authors.affiliation: Obstetrics & Gynecology, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Tsunemi
authors.affiliation: Obstetrics & Gynecology, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Sado
authors.affiliation: Commission for Brain Stroke, Japan Society for the Study of Hypertension in Pregnancy, Tokyo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Suzuki
authors.affiliation: Neurosurgery, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Nakase
authors.affiliation: Obstetrics & Gynecology, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Kobayashi