Intracranial haemorrhage as a cause of maternal mortality during 1991-1992 in Japan: a report of the Confidential Inquiry into Maternal Deaths Research Group in Japan.

OBJECTIVE: To determine the causes of maternal deaths by intracranial haemorrhage in Japan.
DESIGN: Retrospective analysis of records relating to maternal deaths in 1991 and 1992. SAMPLES: Two hundred and thirty maternal deaths, including 25 cases of primary intracranial haemorrhage and two cases with secondary bleeding.
METHODS: Attending doctors were interviewed and completed a 600-item data collection instrument for each maternal death. An expert committee reviewed the data for each death to determine whether the maternal deaths could have been prevented. MAIN OUTCOME MEASURES: Preventability of maternal death from intracranial haemorrhage treated in obstetric and emergency services in Japan.
RESULTS: Half of the primary intracranial haemorrhages occurred during pregnancy, 20% during labour, and 30% in the postnatal period. Neurosurgeons considered that there were only three women in whom surgical drainage was indicated. The committee determined that there was only one maternal death which had a > or = 70% of being prevented. After detailed discussion of each case, 60% of the women (15/25) may have been saved by earlier and more intensive medical intervention.
CONCLUSIONS: These findings suggest that detailed history taking and early diagnosis of intracranial haemorrhage would be helpful. Regionalisation of obstetric emergency systems are necessary to reduce maternal deaths in Japan due to intracranial haemorrhage.