The Perinatal Committee report: Review of the progress of obstetric healthcare in Japan

IF 1.6 4区 医学 Q3 OBSTETRICS & GYNECOLOGY
Shoji Satoh, Atsuo Itakura, Tomoaki Ikeda, Kentaro Kurasawa, Akihito Nakai
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The nearly logarithmic annual decline in maternal and perinatal mortality rates suggests that, in addition to advances in medicine and healthcare, various types of care for mothers and newborns have played a crucial role in this achievement.</p>\n </section>\n \n <section>\n \n <h3> Method</h3>\n \n <p>From the period of World War II to the postwar era, up to around 1980, and then every decade thereafter, the events and movements surrounding perinatal healthcare in each era were examined from the perspectives of epidemiology, medical/healthcare advancements, and institutional/policy trends.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <div>The major events in each era are outlined as follows:\n <ul>\n \n <li><i>Until around 1980</i>: After World War II, in 1948, several laws were enacted to protect mothers and fetuses, including the Maternal and Child Health Handbook, in 1966. The number of births experienced a baby boom for about 10 years following 1945, peaking in 1973. Birthplaces shifted from home deliveries to medical facilities, with doctors becoming the primary birth attendants. Academically, the Japan Association of Obstetricians and Gynecologists (JAOG) for Maternal Protection and the Japan Society of Obstetrics and Gynecology (JSOG) were established in 1949. In the medical field, neonatal intensive care units (NICUs) were introduced and neonatal transport systems became well-established by the 1970s. In 1976, the limit of viability was revised from under 28 weeks of gestation to under 24 weeks. The late 1970s saw the fetal heart rate monitoring, the heartbeat detection using Doppler ultrasound and the ultrasound imaging techniques.</li>\n \n <li><i>1980s</i>: The perinatal medicine became well established, leading to hold The Japan Society of Perinatal Medicine. For fetal management, the fields of fetal diagnosis and fetal treatment entered their early stages with the widespread use of fetal heart rate monitoring and ultrasound imaging. In neonatal care, neonatal transport systems to NICU facilities were enhanced. A major breakthrough in this field was the discovery and widespread use of pulmonary surfactant. Two key concepts that emerged and advanced during this period were maternal transport systems and the Perinatal Maternal and Child Center initiative. In 1987, cases of hepatitis caused by non-heat-treated coagulation products became a major issue. As a result, informed consent affecting mothers and fetuses became a significant point of discussion. The Obstetrics and Gynecology Specialist system was introduced, along with the regular publication of Training Notes for Obstetricians and Gynecologists and Glossary of Obstetrics and Gynecology Terms. As a result of these efforts, both the perinatal mortality rate and the maternal mortality rate were reduced by approximately half over the course of 10 years.</li>\n \n <li><i>1990s</i>: In 1991, the limit of viability was revised to 22 weeks of gestation. In terms of maternal care, nutritional management guidelines for general pregnant women were introduced. In fetal medicine, major topics included the administration of steroids to the mother to promote fetal lung maturation, as well as direct fetal treatments such as shunt procedures and needle aspirations. In neonatal care, inhaled nitric oxide therapy and extracorporeal membrane oxygenation treatment became more widely adopted. Following the Great Hanshin-Awaji Earthquake, in 1995, led to the development of the Disaster Medical Assistance Team and the establishment of Perinatal Maternal and Child Medical Center. In 1996, the Maternal Protection Law was enacted, and the Japan Council for Quality Health Care (JCQHC) was founded to standardize medical care. Asia &amp; Oceania Federation of Obstetrics &amp; Gynecology Journal and Journal of Obstetrics and Gynecology Research were launched as English-language academic journals.</li>\n \n <li><i>2000s</i>: Japan's perinatal mortality rate became the lowest in the world, but the maternal mortality rate was still struggling. Obstetric care changed significantly after an obstetrician was arrested for causing a maternal death during a cesarean section. The JSOG and the JAOG developed practice guidelines describing standard obstetric diagnosis and treatments, and the JCQHC established the Japan Obstetric Compensation System for Cerebral Palsy. In addition, a project to report on maternal deaths by JAOG was also launched, and the combination of these measures led to form a framework of professional autonomy for obstetricians. During this period, brain hypothermic therapy for brain injury was developed.</li>\n \n <li><i>2010s:</i> The Great East Japan Earthquake in 2011 led to major changes in disaster medical planning. This included the introduction of training programs for disaster medical coordinators and the development of disaster-time pediatric and perinatal liaisons. To enhance medical safety, JAOG launched an incidental case reporting system in 2004. Additionally, in 2010, a maternal mortality reporting system was introduced, followed by the maternal severe complications reporting system in 2021. The Japan Council for Implementation of Maternal Emergency Life-Saving System was established, along with the Japan Association for Labor Analgesia, a collaborative council for academic societies and organizations related to painless delivery. 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引用次数: 0

Abstract

Background

Japan's maternal mortality rate and perinatal mortality rate have shown one of the world's most significant declines, positioning Japan at the global forefront of the lowest levels. The nearly logarithmic annual decline in maternal and perinatal mortality rates suggests that, in addition to advances in medicine and healthcare, various types of care for mothers and newborns have played a crucial role in this achievement.

Method

From the period of World War II to the postwar era, up to around 1980, and then every decade thereafter, the events and movements surrounding perinatal healthcare in each era were examined from the perspectives of epidemiology, medical/healthcare advancements, and institutional/policy trends.

Results

The major events in each era are outlined as follows:
  • Until around 1980: After World War II, in 1948, several laws were enacted to protect mothers and fetuses, including the Maternal and Child Health Handbook, in 1966. The number of births experienced a baby boom for about 10 years following 1945, peaking in 1973. Birthplaces shifted from home deliveries to medical facilities, with doctors becoming the primary birth attendants. Academically, the Japan Association of Obstetricians and Gynecologists (JAOG) for Maternal Protection and the Japan Society of Obstetrics and Gynecology (JSOG) were established in 1949. In the medical field, neonatal intensive care units (NICUs) were introduced and neonatal transport systems became well-established by the 1970s. In 1976, the limit of viability was revised from under 28 weeks of gestation to under 24 weeks. The late 1970s saw the fetal heart rate monitoring, the heartbeat detection using Doppler ultrasound and the ultrasound imaging techniques.
  • 1980s: The perinatal medicine became well established, leading to hold The Japan Society of Perinatal Medicine. For fetal management, the fields of fetal diagnosis and fetal treatment entered their early stages with the widespread use of fetal heart rate monitoring and ultrasound imaging. In neonatal care, neonatal transport systems to NICU facilities were enhanced. A major breakthrough in this field was the discovery and widespread use of pulmonary surfactant. Two key concepts that emerged and advanced during this period were maternal transport systems and the Perinatal Maternal and Child Center initiative. In 1987, cases of hepatitis caused by non-heat-treated coagulation products became a major issue. As a result, informed consent affecting mothers and fetuses became a significant point of discussion. The Obstetrics and Gynecology Specialist system was introduced, along with the regular publication of Training Notes for Obstetricians and Gynecologists and Glossary of Obstetrics and Gynecology Terms. As a result of these efforts, both the perinatal mortality rate and the maternal mortality rate were reduced by approximately half over the course of 10 years.
  • 1990s: In 1991, the limit of viability was revised to 22 weeks of gestation. In terms of maternal care, nutritional management guidelines for general pregnant women were introduced. In fetal medicine, major topics included the administration of steroids to the mother to promote fetal lung maturation, as well as direct fetal treatments such as shunt procedures and needle aspirations. In neonatal care, inhaled nitric oxide therapy and extracorporeal membrane oxygenation treatment became more widely adopted. Following the Great Hanshin-Awaji Earthquake, in 1995, led to the development of the Disaster Medical Assistance Team and the establishment of Perinatal Maternal and Child Medical Center. In 1996, the Maternal Protection Law was enacted, and the Japan Council for Quality Health Care (JCQHC) was founded to standardize medical care. Asia & Oceania Federation of Obstetrics & Gynecology Journal and Journal of Obstetrics and Gynecology Research were launched as English-language academic journals.
  • 2000s: Japan's perinatal mortality rate became the lowest in the world, but the maternal mortality rate was still struggling. Obstetric care changed significantly after an obstetrician was arrested for causing a maternal death during a cesarean section. The JSOG and the JAOG developed practice guidelines describing standard obstetric diagnosis and treatments, and the JCQHC established the Japan Obstetric Compensation System for Cerebral Palsy. In addition, a project to report on maternal deaths by JAOG was also launched, and the combination of these measures led to form a framework of professional autonomy for obstetricians. During this period, brain hypothermic therapy for brain injury was developed.
  • 2010s: The Great East Japan Earthquake in 2011 led to major changes in disaster medical planning. This included the introduction of training programs for disaster medical coordinators and the development of disaster-time pediatric and perinatal liaisons. To enhance medical safety, JAOG launched an incidental case reporting system in 2004. Additionally, in 2010, a maternal mortality reporting system was introduced, followed by the maternal severe complications reporting system in 2021. The Japan Council for Implementation of Maternal Emergency Life-Saving System was established, along with the Japan Association for Labor Analgesia, a collaborative council for academic societies and organizations related to painless delivery. Suicide as a significant cause of maternal death led to the establishment of the “Mother and Child Mental Forum” academic conference, which later evolved into the Mental Health Care for Mother & Child training program. In the field of prenatal testing, non-invasive prenatal testing was introduced as a clinical research initiative.
  • From 2020 onward: The year 2020 began with the global outbreak of COVID-19. Until 2023, numerous issues arose due to repeated pandemics, including delivery methods and locations for COVID-positive pregnant women, standard precautions during labor, mother-infant separation after birth, vaccination, so on. JSOG and JAOG worked together to address these challenges. The most pressing issue in the perinatal field is the declining birth rate. Alongside an aging workforce of physicians and a shortage of successors, the decrease in new obstetric clinic openings has become a major concern. By 2024, the decrease in the number of full-time obstetricians and the overtime work limits in Medical Care Act are making it necessary to reconsider the structure of obstetric medical services. Japan's perinatal care system, which has maintained the highest global standards, now stands at a major crossroads.

Conclusion

Researchers (clinicians), academic societies, and professional organizations, centered on the mother and child, have collaborated with support from the government, making progress and building the current safe pregnancy and childbirth management system. However, significant issues remain that need urgent attention, including regulations on overtime work, securing obstetrician numbers, the rapid decline in childbirth facilities, and the functional collapse of perinatal maternal-child healthcare centers. These are critical challenges that must be addressed promptly.

Abstract Image

围产期委员会的报告:审查日本产科保健的进展情况
日本的孕产妇死亡率和围产期死亡率下降幅度居世界前列,处于全球最低水平的前列。孕产妇和围产期死亡率每年几乎呈对数下降表明,除了医学和保健方面的进步外,对母亲和新生儿的各种护理在取得这一成就方面也发挥了关键作用。方法从第二次世界大战至战后,直至1980年前后,此后每隔十年,从流行病学、医学/卫生保健进步和制度/政策趋势的角度考察每个时代围绕围产期保健的事件和运动。结果每个时代的主要事件概述如下:直到1980年左右:第二次世界大战结束后,1948年颁布了几项保护母亲和胎儿的法律,包括1966年的《妇幼保健手册》。1945年之后的10年里,日本经历了婴儿潮,1973年达到顶峰。分娩地点从在家分娩转移到医疗机构,医生成为主要的助产士。在学术上,1949年成立了日本产妇保护妇产科医师协会(JAOG)和日本妇产科学会(JSOG)。在医疗领域,新生儿重症监护病房(NICUs)被引入,新生儿运输系统在20世纪70年代建立起来。1976年,生存能力的限制从28周以下修改为24周以下。20世纪70年代末出现了胎儿心率监测、多普勒超声检测和超声成像技术。20世纪80年代:围产期医学得到了很好的建立,导致了日本围产期医学会。在胎儿管理方面,随着胎儿心率监测和超声成像的广泛应用,胎儿诊断和胎儿治疗领域进入了早期阶段。在新生儿护理方面,新生儿到新生儿重症监护病房的转运系统得到了加强。肺表面活性剂的发现和广泛应用是这一领域的重大突破。在此期间出现和发展的两个关键概念是产妇运输系统和围产期妇幼中心倡议。1987年,由未经热处理的凝血产品引起的肝炎病例成为一个主要问题。因此,影响母亲和胎儿的知情同意成为一个重要的讨论点。引入了妇产科专家系统,并定期出版了《妇产科医生培训说明》和《妇产科术语词汇表》。由于这些努力,围产期死亡率和产妇死亡率在10年期间减少了大约一半。1990年代:1991年,生存能力限制修改为妊娠22周。在产妇保健方面,介绍了一般孕妇的营养管理准则。在胎儿医学中,主要的主题包括给母亲类固醇以促进胎儿肺成熟,以及直接的胎儿治疗,如分流手术和穿刺。在新生儿护理中,吸入性一氧化氮治疗和体外膜氧合治疗越来越被广泛采用。1995年阪神-浅地大地震后,成立了灾难医疗救援队,并成立了围产期母婴医疗中心。1996年,颁布了《产妇保护法》,并成立了日本优质保健委员会(JCQHC),以使医疗保健标准化。亚洲,大洋洲产科学联合会;《妇科杂志》和《妇产科研究杂志》创刊为英文学术期刊。2000年代:日本的围产期死亡率成为世界上最低的,但产妇死亡率仍在挣扎。一名产科医生因在剖宫产过程中造成产妇死亡而被捕后,产科护理发生了重大变化。JSOG和JAOG制定了描述标准产科诊断和治疗的实践指南,jjcqhc建立了日本脑瘫产科补偿制度。此外,还启动了一个由联合督察组报告产妇死亡情况的项目,这些措施结合起来形成了产科医生专业自主的框架。 在此期间,开发了脑低温治疗脑损伤。2010年代:2011年东日本大地震导致灾难医疗规划发生重大变化。这包括为灾害医疗协调员引入培训方案,并发展灾害期间的儿科和围产期联络。为加强医疗安全,医管局于2004年推出意外个案报告制度。此外,2010年引入了孕产妇死亡率报告系统,随后于2021年引入了孕产妇严重并发症报告系统。日本产妇紧急救生系统实施委员会与日本分娩镇痛协会一道成立,后者是一个由与无痛分娩有关的学术团体和组织组成的合作委员会。自杀作为产妇死亡的一个重要原因,促使成立了“母亲与儿童精神论坛”学术会议,该会议后来演变为“母亲精神保健”;儿童培训计划。在产前检查领域,无创产前检查作为一项临床研究倡议被引入。2020年伊始,2019冠状病毒病在全球爆发。直到2023年,由于反复出现的大流行,出现了许多问题,包括新冠病毒阳性孕妇的分娩方法和地点、分娩期间的标准预防措施、分娩后的母婴分离、疫苗接种等。JSOG和JAOG共同努力应对这些挑战。围产期领域最紧迫的问题是出生率下降。随着医生队伍的老龄化和继任者的短缺,新产科诊所开业的减少已成为一个主要问题。到2024年,由于全职产科医生人数的减少以及《医疗保健法》对加班的限制,有必要重新考虑产科医疗服务的结构。日本的围产期保健制度一直保持着全球最高的标准,现在站在一个重要的十字路口。结论科研人员(临床医生)、学术团体和专业组织以母婴为中心,在政府的支持下通力合作,取得了一定进展,建立了现行的安全孕产管理体系。然而,仍然有一些重大问题需要紧急关注,包括加班规定、产科医生人数的保障、分娩设施的迅速减少以及围产期妇幼保健中心的功能崩溃。这些都是必须迅速应对的重大挑战。
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来源期刊
CiteScore
3.10
自引率
0.00%
发文量
376
审稿时长
3-6 weeks
期刊介绍: The Journal of Obstetrics and Gynaecology Research is the official Journal of the Asia and Oceania Federation of Obstetrics and Gynecology and of the Japan Society of Obstetrics and Gynecology, and aims to provide a medium for the publication of articles in the fields of obstetrics and gynecology. The Journal publishes original research articles, case reports, review articles and letters to the editor. The Journal will give publication priority to original research articles over case reports. Accepted papers become the exclusive licence of the Journal. Manuscripts are peer reviewed by at least two referees and/or Associate Editors expert in the field of the submitted paper.
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