Evaluation and care protocol for maternal emergencies: the basic J-CIMELS protocol derived from the Kyoto protocol

The Japan Council for Implementation of the Maternal Emergency Life Support System (J-CIMELS) adopted the “Kyoto protocol”—which the Kyoto Society for Emergency Response in Obstetrics and Gynecology proposed in 2010—as the “evaluation and care protocol” intended to prevent the progression of pathologic conditions in expectant and nursing mothers by detecting maternal emergencies at an early stage and by taking appropriate and required measures. The protocol also incorporates maternal care including obstetric cardiopulmonary resuscitation (CPR) in the event that pathologic conditions deteriorate further despite the measures taken. The J-CIMELS aims to popularize the protocol among medical professionals involved in perinatal care. The protocol sets forth procedures that the first detector at any obstetric institution should follow. Specifically, the protocol describes monitoring the patient’s vital signs to assess breathing, circulation, and level of consciousness, recommends simple, appropriate approaches for oxygenation and transfusion that are indispensable in maternal emergencies, and provides steps to be taken for immediate measures and the use of an automated external defibrillator and adrenaline in obstetric CPR. The J-CIMELS developed a basic simulation-based practical training course, in which trainees carry out the required measures as per the protocol through simulated maternal emergencies, and has held the course throughout Japan since 2015. Popularization of the protocol is expected to reduce the number of maternal deaths in Japan.