Japan Maternal Death Exploratory Committee (JMDEC)
About JMDEC
Japan has established a nationwide, structured system for the review of maternal deaths through the Japan Maternal Death Exploratory Committee (JMDEC), coordinated by the Japan Association of Obstetricians and Gynecologists.
Since 2010, all maternal deaths in Japan have been systematically reported, anonymized, and reviewed by a multidisciplinary expert panel. Clinical records, imaging data, laboratory findings, and when available, autopsy reports are comprehensively analyzed.
In addition to maternal death review, JMDEC has expanded its scope since 2021 to include severe maternal morbidity (“near-miss”) cases and large-scale database analyses, further strengthening its role as a comprehensive national surveillance system.
Mission Statement
To reduce preventable maternal deaths and severe maternal morbidity by providing high-quality multidisciplinary analysis and actionable recommendations, thereby improving the safety and quality of maternal care in Japan.
Aims and Scope
- To establish a nationwide standardized system for the registration and review of maternal deaths and severe maternal morbidity.
- To identify clinical, systemic, and social factors associated with adverse maternal outcomes.
- To evaluate preventability and contributing factors through multidisciplinary review.
- To develop evidence-based recommendations and disseminate them nationwide.
- To promote a culture of patient safety, transparency, and continuous quality improvement in obstetric care.
Current Activities and Achievements
1. National Maternal Death Review System (2010–present)
Comprehensive nationwide registration and expert review of maternal deaths. Over 590 cases have been analyzed to date.
2. Severe Maternal Morbidity (Near-Miss) Registration (2021–present)
A prospective registration system for severe, life-threatening obstetric conditions has been introduced, focusing on six high-impact disorders:
- Amniotic fluid embolism
- Intracranial hemorrhage
- Invasive group A streptococcal infection
- Pulmonary thromboembolism
- Peripartum cardiomyopathy
- Aortic dissection
This initiative enables comparative analysis between survival and fatal cases, providing deeper insights into early recognition, management, and prevention.
3. Large-Scale Database Analysis (DPC-based Studies)
JMDEC utilizes nationwide administrative and clinical databases, including the Diagnosis Procedure Combination (DPC) system, to conduct large-scale epidemiological analyses.
These data allow:
- Population-level assessment of maternal complications
- Identification of rare but critical conditions
- Evaluation of healthcare system performance and regional disparities
This approach complements case-based reviews by adding quantitative, nationwide statistical perspectives.
4. Annual Reports and Recommendations (Proposals for improving maternal safety)
Findings are summarized annually and translated into practical clinical recommendations, contributing to measurable reductions in preventable deaths.(ref 1)
5. Trend Analysis and Policy Impact
Significant reduction in deaths due to obstetric hemorrhage was achieved after implementation of national safety initiatives, although recent trends indicate emerging challenges such as placenta accreta spectrum and advanced maternal age.
6. Multidisciplinary Review Framework
Reviews involve obstetricians, anesthesiologists, emergency physicians, pathologists, forensic experts, and psychiatrists, ensuring comprehensive evaluation.
International Collaboration
JMDEC collaborates with global maternal health networks, including:
- International Network of Obstetric Survey Systems
- MBRRACE-UK
Funding and Organization
JMDEC is supported by national research funding from the Ministry of Health, Labour and Welfare of Japan and operates under the framework of the Japan Association of Obstetricians and Gynecologists (JAOG), with contributions from academic institutions and clinical facilities nationwide.
Key Strengths
- Integration of maternal death + near-miss + big data (DPC)
- Combination of qualitative case review and quantitative epidemiology
- Strong linkage to national recommendations and education systems
- Demonstrated impact on maternal safety in Japan
Ref.
Proposals for improving maternal safety (2023 edition): Insights from the analysis of maternal deaths in Japan
Japan Maternal Death Exploratory Committee.
J Obstet Gynaecol Res. 2025;51:e16244.
