Abstract
Dysfunction of the maternal emergency medical system in Japan has recently received considerable social issue. No study has thoroughly investigated the present situation of this system in tertiary emergency centers in Japan. We performed a questionnaire survey targeting all 210 tertiary emergency centers in Japan to elucidate the points at issue concerning this system. The questionnaire included questions on types of facilities, availability of a neonatal intensive care unit (NICU), availability of obstetric treatment, annual number and reasons for admission of obstetric inpatients and maternal shock patients, and maternal deaths in each facility. We received responses from 131 tertiary emergency centers (coverage rate 62.4%) of which 30 were general perinatal medical centers and 46 were regional perinatal medical centers. Perinatal medical centers accounted for 58% of participating centers. A NICU was available in 83 facilities (63.4%), and obstetric treatment was always available in 113 facilities (86.3%). The annual number of obstetric inpatients in all participating facilities was 384, which accounted for 0.1% of all hospital inpatients in the facilities. There were discrepancies in the annual number of obstetric inpatients (0-35) treated at the facilities. Eight facilities (6.1%) admitted more than 11 obstetric patients in 1 year, whereas 50 facilities (38.2%) did not admit any obstetric patients at all. Of all obstetric inpatients, 135 (35.2%) were diagnosed with shock and 19 (4.9%) were maternal deaths. In conclusion, both the percentage of hospital obstetric inpatients and the mortality rate of these patients were low in the tertiary emergency centers in Japan. The discrepancies among the surveyed facilities in the annual number of obstetric patients treated suggest that there is still room for improvement of the tight relationship between the tertiary emergency centers and obstetric departments, especially in the perinatal medical centers.
