Proposals for Improving Maternal Safety (2024 Edition): Insights From the Analysis of Maternal Deaths in Japan.

The Proposals for Improving Maternal Safety (2024 Edition) were developed by the Japan Maternal Death Exploratory Committee and the Japan Association of Obstetricians and Gynecologists based on systematic reviews of 640 maternal deaths reported nationwide between 2010 and 2024. Obstetric hemorrhage remained the leading cause of maternal death, followed by intracranial hemorrhage, amniotic fluid embolism, suicide, cardiovascular disease, infection, and pulmonary disease. In 2024, maternal deaths increased sharply to 47, largely driven by a resurgence of hemorrhage-related deaths, while suicide has persistently ranked among the top causes in recent years. Detailed analysis revealed preventable system-level failures in diagnosis, timing of intervention, and interdisciplinary collaboration. Based on these findings, five key proposals are presented: (1) Immediate recognition and correction of consumptive coagulopathy in placental abruption with fetal death, emphasizing early fibrinogen measurement and replacement. (2) Prompt re-laparotomy when cesarean suture dehiscence is suspected, as balloon tamponade and arterial embolization are ineffective for structural lesions. (3) Active implementation of the Mississippi protocol for HELLP (hemolysis, elevated liver enzyme levels, and low platelet count) syndrome to prevent fatal cerebral hemorrhage. (4) Prevention of maternal suicide through regional collaboration among obstetrics, psychiatry, and administrative agencies, combined with a population-based mental health approach. (5) Appropriate and proactive intervention for hyperemesis gravidarum, recognizing its association with severe physical complications and maternal mental health deterioration. These proposals highlight urgent priorities for clinical practice, education, and system reform to reduce preventable maternal deaths in Japan.