How to lower perinatal mortality? Perinatal care in Japan.

OBJECTIVE To review the 30-year history of perinatal medical care in Japan, and the recently initiated regionalization system of perinatal centers, new technologies and treatments in obstetric and neonatal medicine developed in Japan. STATISTICAL DATA: Maternal and neonatal health statistics of Japan released by the Ministry of Health and Welfare, Japanese Society of Obstetrics and Gynecology, Japanese Pediatric Society, and Tokyo Women's Medical University. LABORATORY DATA Serological assay and immunohistochemical staining employing TKH-2 antibody for the diagnosis of amniotic fluid embolism, and assaying granulocyte elastase as a specific inflammatory marker in mucous samples from the uterine cervical canal for the prediction of preterm labor or premature rupture of membranes. TREATMENTS Urinary trypsin inhibitor (Urinastatin) for the prevention of preterm delivery, and a double-blind, placebo-controlled, randomized trial of antithrombin-III therapy in severe preeclampsia. CONCLUSION Over the last 30 years, the statistical data of perinatal health care, such as maternal and perinatal mortality rates, have markedly improved in Japan. These results are supported by the advanced technologies and newly developed treatments in obstetric and neonatal medicine. The regionalization of perinatal centers, a national project in order to assure a systematic collaboration among primary, secondary, and tertiary centers, has just started in Japan. It also aims at systematization of the function of perinatal centers on the national level through the informative promoting action.