Decline in maternal death due to obstetric haemorrhage between 2010 and 2017 in Japan.

This descriptive study was based on the maternal death registration system established by the Japan Association of Obstetricians and Gynecologists and the Maternal Death Exploratory Committee (JMDEC). 361 women died during pregnancy or within 42 days after delivery between January 2010 and June 2017 throughout Japan were analysed, in order to investigate the trend in maternal deaths related to obstetric medical practice. Reports of maternal death were consistent, ranging from 45 cases in 2010 to 44 cases in 2017. Among all maternal deaths, the frequency of deaths due to obstetric haemorrhage ranged from 29% (2010) to 7% (2017) (p < 0.001). The causes of obstetric haemorrhage have progressively reduced, especially maternal deaths due to uterine inversion and laceration have not occurred since 2014. The remaining causes of obstetric haemorrhage-related maternal deaths were placenta accreta spectrum, placental abruption, and severe forms of uterine focused amniotic fluid embolism. We believe the activities of the JMDEC including annual recommendations and simulation programs are improving the medical practices of obstetric care providers in Japan, resulting in a reduction of maternal deaths due to obstetric haemorrhage.

Coping with the Present Situation Surrounding Emergency Care to Pregnant Women / 日本農村医学会雑誌

We discussed the current state of the emergency care of pregnant women and better ways to solve the problems confronting obstetricians and hospitals in our country.The basis of this problem is that doctors specialized in obstetrics and gynecology are working hard at high risk of being sued, resulting in the rapid decrease in the number of obstetricians. It has become difficult for many hospitals to maintain the department of obstetrics and gynecology. In other arords, it boils down to how to increase, or at least not to decrease the number of obstetricians and how to use present working doctors efficiently. By so doing, we could take in more emergency patients. To incease the number of those who choose obstetrics and gynecology, we should emphasize attrctive aspects of obstetrics and gynecology to students in early grades of medical schools. To assist the women doctors' return after maternity leave in taking care of their child, 24-hour day nurseries are necessary. Construction of the systems of short time work to reduce their hard and long-time load is also needed.In addition, the effective regional hospital association and cooperation should be encouraged and prompt maternal transportation should be achieved as much as possible. Doctors of different clinics or hospitals are expected to join forces to replenish the work of a regional perinatal central hospital. There are many of the medical treatment lawsuit when the newborn baby with cerebral palsy is born. This is one reason why the doctors keep away from obstetrics. A new system of the nofault amends system may be established by which the load of medical providers and patients can be reduced. Increased salary for obstetrician may be effective to induce doctors to obstetrics. These points were discussed.