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Causes of Maternal Mortality in Japan
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 (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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Kilpatrick, S. J., Crabtree, K. E., Kemp, A., & GELLER, S. E. (2002) · Obstetrics and Gynecology · doi:10.1097/00006250-200208000-00020 · Cited by 3
Yuan, P., Yin, S., Guo, X., Yang, J., Li, L., Wei, Y., & Zhao, Y. (2026) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-026-08759-1 · Cited by 2
“Prior to the implementation of 7-day health service pro-vision policies in many countries [1–3], a seminal study investigating nearly 4 million consecutive hospitalizations over a decade in Canada [4] reported that week-end admissions were associated with higher mortality rates for 23 of the 100…”
InfluentialMultigravid Women with Uterine Rupture: A Case Report
Basir, F., Abadi, A., Martadiansyah, A., Kesty, C., Aryani, F. S., & Latifah, M. E. (2021) · Bioscientia Medicina Journal of Biomedicine and Translational Research · doi:10.37275/bsm.v6i2.443 · Cited by 2
“due to peritoneal stimulation; (4) shock, fast and irregular heartbeat, dropping blood pressure; (5) vaginal bleeding, usually in small amount especially if the fetus head descends and obstructs the birth canal; (6) sometimes pain can radiate to lower extremities and shoulders; (7) loss of uterine contraction; (8) mus…”
BackgroundMethodIshikawa, S., Ishikawa, H., Sato, M., Nagasawa, A., Suzuki, Y., Okayama, J., Nakada, E., Omoto, A., Shozu, M., & Koga, K. (2023) · Journal of obstetrics and gynaecology research · doi:10.1111/jog.15838 · Cited by 3
“4 Therefore, early transfer from primary delivery handling facilities to highly advanced facilities with intensive care units is necessary to provide appropriate intensive care.”
BackgroundMORTALIDADE MATERNA NO ESTADO DO RIO GRANDE DO SUL, BRASIL, NO PERÍODO DE 1999 A 2008.
Carreno, I. (2012) · Americanae (AECID Library) · Cited by 2
Furukawa, S., & Sameshima, H. (2015) · Obstetrics and Gynecology International · doi:10.1155/2015/269156 · Cited by 1
“Two patients were subjected to inappropriate practices involving delay in diagnosis, delay in transfer, and inadequate fluid replacement survived (Cases 2 and 5).”
BackgroundDo uterotrophic drugs increase the risk of fatal hemorrhagic brain stroke?
Yamada, T., Yamada, T., Morikawa, M., Takeda, M., Akaishi, R., Nishida, R., Araki, N., Koyama, T., & Minakami, H. (2010) · Journal of Perinatal Medicine · doi:10.1515/jpm.2010.116 · Cited by 1
Severe Aneurysmal Subarachnoid Hemorrhage after Warning Headache during Pregnancy: A Case Report
Hironaka, K., Suzuki, M., Tateyama, K., Ozeki, T., Adachi, K., & Morita, A. (2020) · Journal of Nippon Medical School · doi:10.1272/jnms.jnms.2020_87-308 · Cited by 1
Maeda, A., & Camann, W. (2025) · British Journal of Anaesthesia · doi:10.1016/j.bja.2025.02.028 · Cited by 1
Medical and obstetric problems complicating pregnancy
Hoesli, I. M., Louwen, F., & Holzgreve, W. (2001) · Current Opinion in Anaesthesiology · doi:10.1097/00001503-200106000-00003 · Cited by 1
Pregnancy and venous thrombosis
Neki, R. (2022) · Japanese Journal of Thrombosis and Hemostasis · doi:10.2491/jjsth.33.448 · Cited by 1
The rational use of blood and its components in obstetrical and gynecological bleeding complications
Downes, K. A., & Sarode, R. (2006) · Cambridge University Press eBooks · doi:10.1017/cbo9780511526978.018
Maternal mortality, Postpartum haemorrhage, Sepsis, Eclampsia, Anaemia
Kaur, H., Singh, S., & Goyal, L. D. (2013)
MATERNAL MORTALITY IN A TERTIARY CARE CENTRE
Kaur, H., Singh, S., & Goyal, L. D. (2013) · Journal of Evolution of Medical and Dental Sciences · doi:10.14260/jemds/839
Rotura uterina tras parto vaginal con distocia de hombros
Martínez, T. C., Martínez, T. D., Urruzola, I. M., de la Rosa, J. H., & Padilla, M. F. (2012) · Progresos de Obstetricia y Ginecología · doi:10.1016/j.pog.2012.05.002
Richa, F., Karim, N., & Yazbeck, P. H. (2015)
Zhang, W., Alexander, S., Bouvier‐Colle, M., Macfarlane, A., & Stat, D. (2012)
The Role of the Anesthesiologist in Dealing with Massive Obstetric Hemorrhage
Taniguchi, M. (2011) · THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA · doi:10.2199/jjsca.31.407
Hirose, N., Ohkuchi, A., Baba, Y., Usui, R., Hirashima, C., Watanabe, T., & Matsubara, S. (2016) · Hypertension Research in Pregnancy · doi:10.14390/jsshp.hrp2015-014
“0 g/dl, (2) SBP of < 80 mmHg, or (3) a complication of disseminated intravascular coagulation (DIC) according to the obstetrical DIC score;14,15) however, we did not use SI for the decision”
MethodOsato, K. (2018) · Springer eBooks · doi:10.1007/978-981-10-1993-7_8
Langat, A. K. (2019) · Annals of Biostatistics & Biometric Applications · doi:10.33552/abba.2019.01.000514
Mhyre, J. M. (2009) · Elsevier eBooks · doi:10.1016/b978-0-323-05541-3.00039-9
Labor Analgesia in Japan；Anesthesiologists’ Perspectives
Nagasaka, Y., Kume, C., & Miyasaka, K. (2023) · THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA · doi:10.2199/jjsca.43.347
Metadata
- 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
- 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 › Medicine › Pediatrics, Perinatology and Child Health › 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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