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Cited by 102Maternal and fetal healthcareGlobal Maternal and Child HealthMaternal and Neonatal Healthcare

Causes of Maternal Mortality in Japan

Nagaya, Ken·2000·JAMA
DOI 10.1001/jama.283.20.2661
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Abstract

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. JAMA. 2000;283:2661-2667.

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  • The most common causes of maternal morbidity and mortality-hemorrhage, hypertensive disorders, infection, and sepsis-are often preceded by predictable vital signs perturbations in both high-resource and low-resource settings, and early intervention is key to improving outcomes.

    “The most common causes of maternal morbidity and mortality—hemorrhage, hypertensive disorders, infection, and sepsis—are often preceded by predictable vital signs perturbations in both high-resource and low-resource settings, and early intervention is key to improving outcomes (4–9).”

    From Comprehensive pregnancy monitoring with a network of wireless, soft, and flexible sensors in high- and low-resource health settings (2021) · cites this paper as [8]

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Authors
Nagaya, K.
Corresponding author
Nagaya, Ken
ORCID
Nagaya, Ken
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2000-05-24
Volume
283
Issue
20
Pages
2661
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.283.20.2661
OpenAlex
W2121826252
Cited by
102
References
11
Citations by year
2026: 1 · 2025: 4 · 2024: 1 · 2023: 4 · 2022: 2 · 2021: 7 · 2020: 4 · 2019: 2 · 2018: 4 · 2017: 2 · 2016: 8 · 2015: 5 · 2014: 5 · 2013: 7 · 2012: 8
FWCI
3.94
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
  • Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
Keywords
maternal mortality, causes of maternal death, preventable maternal deaths, obstetric hemorrhage, high-risk obstetric care
MeSH terms
Adolescent, Adult, Cause of Death, Cross-Sectional Studies, Delivery of Health Care, Female, Humans, Japan, Maternal Health Services, Maternal Mortality, Middle Aged, Obstetrics, Pregnancy, Pregnancy Complications

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