Proposals for improving maternal safety (2023 edition): Insights from the analysis of maternal deaths in Japan

The maternal mortality rate remains approximately 4 per 100 000 deliveries. Between January 2010 and July 2024, 629 maternal deaths were reported, of which 590 were reviewed. The Maternal Safety Proposal summarizes these cases. Deaths from obstetric hemorrhage decreased from 28% in 2010 to 7% in 2019 but rose to approximately 20% in 2022 and dropped to 10% in 2023. In the past 4 years, suicide has surpassed obstetric hemorrhage as a leading cause of death. In 2023, intracranial hemorrhage/infarction became the leading cause, with six cases reported. Cardiopulmonary collapse from amniotic fluid embolism, along with cardiovascular, infectious, and pulmonary diseases, has remained stable at 6%-10%. Initial symptoms leading to death occurred during the antepartum (38%), intrapartum (41%), or postpartum periods (21%), with cases distributed across general hospitals, small maternity delivery facilities, and non-medical settings, including homes. The following are the year's maternal safety proposals: For pregnant women experiencing anxiety, a comprehensive evaluation addressing biological, psychological, and social factors should be conducted to identify key problem areas. Epidural analgesia during labor carries the risk of serious complications. Obstetricians and anesthesiologists must be aware of these risks to ensure the proper management of anesthesia and delivery. Pregnant and postpartum women are at a high risk of invasive group A streptococcal infections, and early screening and timely intervention should be prioritized. Pathological autopsy remains the most effective method for determining the cause of death and should be recommended to bereaved families in all cases of maternal death.