{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T02:06:45Z","timestamp":1773022005848,"version":"3.50.1"},"reference-count":18,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2023,4,17]],"date-time":"2023-04-17T00:00:00Z","timestamp":1681689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Unlike Europe and the United States, Japan has seen numerous maternal deaths from hemorrhagic strokes related to hypertensive disorders of pregnancy (HDP). This study retrospectively analyzed deaths associated with HDP-related hemorrhagic stroke in Japan to determine the number of deaths that may have been prevented with blood pressure control during pregnancy. Methods: This study included maternal deaths related to hemorrhagic stroke cases. The proportion of patients without proteinuria whose blood pressure exceeded 140\/90 mmHg between 14+0 and 33+6 weeks of gestation were determined. Lastly, the application of tight antihypertensive management was evaluated. Results: Among 34 HDP-related maternal deaths, 4 cases involved patients without proteinuria whose blood pressures exceeded 140\/90 mmHg between 14+0 and 33+6 weeks of gestation. These included two chronic hypertension and two gestational hypertension cases. None of the patients received antihypertensive agents, and their blood pressures were managed leniently. Conclusion: Among HDP-related hemorrhagic stroke deaths in Japan, only a few cases of maternal death could have been prevented with tight blood pressure management, as described in the CHIPS randomized controlled trial. Therefore, to prevent HDP-related hemorrhagic stroke in Japan, new preventive strategies during pregnancy should be established.<\/jats:p>","DOI":"10.3390\/jcm12082908","type":"journal-article","created":{"date-parts":[[2023,4,17]],"date-time":"2023-04-17T03:14:09Z","timestamp":1681701249000},"page":"2908","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Are There Maternal Deaths Related to Hemorrhagic Stroke Due to Hypertensive Disorder of Pregnancy That Could Be Potentially Preventable by Tight Hypertension Management in Antepartum? A Retrospective Study from the Maternal Death Exploratory Committee in Japan"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1760-691X","authenticated-orcid":false,"given":"Hiroaki","family":"Tanaka","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Mie University School of Medicine, Edobashi 2-174, Tsu 514-8507, Mie, Japan"},{"name":"Japan Maternal Death Exploratory Committee, Ichigayahachimantyou 14, Shinjuku, Tokyo 162-0844, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5789-1022","authenticated-orcid":false,"given":"Junichi","family":"Hasegawa","sequence":"additional","affiliation":[{"name":"Japan Maternal Death Exploratory Committee, Ichigayahachimantyou 14, Shinjuku, Tokyo 162-0844, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shinji","family":"Katsuragi","sequence":"additional","affiliation":[{"name":"Japan Maternal Death Exploratory Committee, Ichigayahachimantyou 14, Shinjuku, Tokyo 162-0844, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kayo","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Japan Maternal Death Exploratory Committee, Ichigayahachimantyou 14, Shinjuku, Tokyo 162-0844, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatsuya","family":"Arakaki","sequence":"additional","affiliation":[{"name":"Japan Maternal Death Exploratory Committee, Ichigayahachimantyou 14, Shinjuku, Tokyo 162-0844, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masamitsu","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Japan Maternal Death Exploratory Committee, Ichigayahachimantyou 14, Shinjuku, Tokyo 162-0844, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eijiro","family":"Hayata","sequence":"additional","affiliation":[{"name":"Japan Maternal Death Exploratory Committee, Ichigayahachimantyou 14, Shinjuku, Tokyo 162-0844, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahiko","family":"Nakata","sequence":"additional","affiliation":[{"name":"Japan Maternal Death Exploratory Committee, Ichigayahachimantyou 14, Shinjuku, Tokyo 162-0844, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2249-1333","authenticated-orcid":false,"given":"Akihiko","family":"Sekizawa","sequence":"additional","affiliation":[{"name":"Japan Maternal Death Exploratory Committee, Ichigayahachimantyou 14, Shinjuku, Tokyo 162-0844, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isamu","family":"Ishiwata","sequence":"additional","affiliation":[{"name":"Japan Maternal Death Exploratory Committee, Ichigayahachimantyou 14, Shinjuku, Tokyo 162-0844, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomoaki","family":"Ikeda","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Mie University School of Medicine, Edobashi 2-174, Tsu 514-8507, Mie, Japan"},{"name":"Japan Maternal Death Exploratory Committee, Ichigayahachimantyou 14, Shinjuku, Tokyo 162-0844, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1161\/HYPERTENSIONAHA.116.07862","article-title":"The CHIPS randomized controlled trial (control of hypertension in pregnancy study): Is severe hypertension just an elevated blood pressure?","volume":"68","author":"Magee","year":"2016","journal-title":"Hypertension"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.preghy.2018.05.004","article-title":"The hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international practice","volume":"13","author":"Brown","year":"2018","journal-title":"Pregnancy Hypertens."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"l5119","DOI":"10.1136\/bmj.l5119","article-title":"Diagnosis and management of hypertension in pregnancy: Summary of updated NICE guidance","volume":"366","author":"Webster","year":"2019","journal-title":"BMJ"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.jacc.2019.10.056","article-title":"Acute stroke during pregnancy and puerperium","volume":"75","author":"Elgendy","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1835","DOI":"10.1253\/circj.CJ-15-0297","article-title":"Maternal death due to stroke associated with pregnancy-induced hypertension","volume":"79","author":"Hasegawa","year":"2015","journal-title":"Circ. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2097","DOI":"10.1080\/14767058.2017.1336222","article-title":"Analysis of preventability of stroke-related maternal death from the nationwide registration system of maternal deaths in Japan","volume":"31","author":"Katsuragi","year":"2018","journal-title":"J. Matern.-Fetal Neonatal Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2066","DOI":"10.1111\/jog.14786","article-title":"Pregnancy-associated hemorrhagic stroke: A nationwide survey in Japan","volume":"47","author":"Enomoto","year":"2021","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1097\/01.AOG.0000126245.35811.2a","article-title":"Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count","volume":"103","author":"Sibai","year":"2004","journal-title":"Obstet. Gynecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/0002-9378(90)90376-I","article-title":"The HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): Much ado about nothing?","volume":"162","author":"Sibai","year":"1990","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"457","DOI":"10.3109\/10641950903572282","article-title":"Are early and late preeclampsia distinct subclasses of the disease\u2014What does the placenta reveal?","volume":"29","author":"Hall","year":"2010","journal-title":"Hypertens. Pregnancy"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1161\/HYPERTENSIONAHA.107.107607","article-title":"Placental origins of preeclampsia: Challenging the current hypothesis","volume":"51","author":"Huppertz","year":"2008","journal-title":"Hypertension"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2370","DOI":"10.1161\/01.STR.28.12.2370","article-title":"Predisposing factors to enlargement of spontaneous intracerebral hematoma","volume":"28","author":"Kazui","year":"1997","journal-title":"Stroke"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"S9","DOI":"10.1016\/j.ajog.2015.08.003","article-title":"Preeclampsia, biomarkers, syncytiotrophoblast stress, and placental capacity","volume":"213","author":"Redman","year":"2015","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"153","DOI":"10.5830\/CVJA-2012-003","article-title":"The role of angiogenic, anti-angiogenic and vasoactive factors in pre-eclamptic African women: Early- versus late-onset preeclampsia","volume":"23","author":"Govender","year":"2012","journal-title":"Cardiovasc. J. Afr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1212\/01.wnl.0000339060.11702.dd","article-title":"Cerebral microbleeds are a risk factor for warfarin-related intracerebral hemorrhage","volume":"72","author":"Lee","year":"2009","journal-title":"Neurology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1588","DOI":"10.1161\/01.STR.0000170642.39876.f2","article-title":"Avoiding central nervous system bleeding during antithrombotic therapy: Recent data and ideas","volume":"36","author":"Hart","year":"2005","journal-title":"Stroke"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e65","DOI":"10.1016\/j.jstrokecerebrovasdis.2013.08.017","article-title":"Pregnancy-associated intracranial hemorrhage: Results of a survey of neurosurgical institutes across Japan","volume":"23","author":"Takahashi","year":"2014","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"9509","DOI":"10.1038\/srep09509","article-title":"A clinical characteristic analysis of pregnancy-associated intracranial haemorrhage in China","volume":"5","author":"Liang","year":"2015","journal-title":"Sci. Rep."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/8\/2908\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:17:09Z","timestamp":1760123829000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/8\/2908"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,17]]},"references-count":18,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,4]]}},"alternative-id":["jcm12082908"],"URL":"https:\/\/doi.org\/10.3390\/jcm12082908","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,17]]}}}