Causes of maternal mortality in Japan.

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.

Use of drugs during pregnancy in Japanese women.

The use of drugs during pregnancy was studied in 890 women, who were delivered of their babies in 11 obstetric departments of general hospitals in Japan, during the one month period of November 1989. Of these women, 889 (99.9%) took one or more drugs during the whole period of pregnancy and the number of drugs taken averaged 9.6. During pregnancy 172 women (19.3%) did not take drugs, and the remaining 718 (80.7%) took a total of 1766 medications. The most commonly used drugs were anti-anemic, anti-abortion medications, digestives, and antimicrobials. Bronchodilators, psychotropic agents, anticonvulsants, and steroids were each prescribed during pregnancy for about 1% of the women. Malformations were found at birth in 12 infants (1.3%). No significant relations were found between these anomalies and ingestion of particular drugs. During pregnancy, 9.3% of the women continued to smoke, and 1.9% continued to consume moderate amounts or more of alcohol. (Tab. 8, Ref. 7.)

Fourteen years' experience of management and use of the perinatal data-base system.

Since 1973, we have been recording the data of all obstetric cases in our department in our original data-base system, which was created on the mainframe computer at the Tokyo University Hospital Computer Center. The purposes of this system are mainly for making summaries of patients, for retrieving information of cases to provide data for clinical investigations, and for collecting statistics. The data records consist of 225 items, including different kinds of perinatal information. Our data-base system has been useful in improving perinatal medicine, in clinical investigations, and in our daily work. But after 14 years of experience with it, we recognize the system has problems, namely: 1) How to summarize perinatal data to be used as a substitute for a patient history chart, and 2) How to update the data-base with a little change in format according to improvements of perinatal medicines.

Formulas for fetal weight estimation by ultrasound measurements based on neonatal specific gravities and volumes.

To improve the accuracy of fetal weight estimation by ultrasound measurement, especially in low birth weight infants, including those with intrauterine growth retardation, two new formulas were developed from a new point of view. The formulas were established by (1) actual measurements of the volumes of the neonatal head and trunk with limbs, (2) analysis of the relationship between the sizes of the parts of the fetal body measured by ultrasound examination before birth and the volumes of the parts of the neonatal body, and (3) calculation of the specific gravities of the parts of the neonatal body. The prospective study showed a high correlation between estimated weights and actual birth weights with a small range of error in infants weighing between 450 and 4800 gm.

Surgical treatment of idiopathic hypertrophic subaortic stenosis in children.

Five children with idiopathic hypertrophic subaortic stenosis (IHSS) were operated upon during the past 7 years and all survived. Their ages ranged from 4 years and 5 months to 14 years (mean 8 years and 5 months). The operations performed were 1 right ventricular myectomy and 4 transaortic left ventricular myotomies. Whether surgery performed in childhood would change the natural history or not is still unknown, however, according to our results and many available reports, we have so far reached the following conclusions; 1. Transaortic left ventrlcular myotomy or myectomy is a safe and effective operation for localized muscular subaortic stenosis in children. 2. Because the disease is progressive, operation in childhood may be worth to be considered, when the resting or provocative pressure gradient is excessive. 3. For those who have a marked increase in left ventricular outflow pressure gradient by the provocation, operation would be considered even though the gradient at rest is less than 50 mmHg.