Origins

CDPH's MCAH Division established CA-PAMR in 2006 following a dramatic rise in California's maternal mortality from 7.7 deaths per 100,000 live births in 1999 to 16.9 deaths per 100,000 live births in 2006. In collaboration with its partners, the CMQCC and PHI, CA-PAMR developed a methodological approach to review deaths during pregnancy and up to a year after end of pregnancy.

Our Goals

To prevent pregnancy-related deaths, reduce associated disparities, and help women optimize their health prior to, during and after pregnancy. To identify opportunities for improvement and develop data-driven actionable recommendations for change.

Our Work

To understand and report comprehensive findings of detailed case reviews of maternal deaths.

Methods for Reviewing Maternal Mortality Cases

Since 2006, CA-PAMR has continued to identify and review deaths that occurred during pregnancy or within one year after the end of pregnancy. Over this period, the CA-PAMR methodology has evolved to improve case identification and the overall review process (for more on this or to review Key Findings, see the CA-PAMR reports page).  The CA-PAMR methods involve the following steps:

• First, a pregnancy-associated death cohort is constructed by linking administrative data sets – maternal death certificate data are linked to birth and fetal demise data, patient discharge and emergency department data using probabilistic data linkage methods.
• Second, inclusion/exclusion criteria are applied to the pregnancy-associated death cohort to identify a subset of potential pregnancy-related cases.
• Third, additional data sources, including investigative reports (coroner, autopsy, toxicology), medical records, and other relevant data are gathered and abstracted to provide more information about this subset of cases. Case summaries are prepared for committee review.
• Next, an appointed, volunteer expert committee reviews all potential pregnancy-related cases to identify the cause of death and timing; contributing/critical factors leading up to death; whether the death was pregnancy-related; degree of preventability; and quality improvement opportunities in maternity care and support.
• Finally, all data from linked administrative datasets, abstracted records, and committee reviews are analyzed using quantitative and qualitative methods and summarized in a publication. The expert committee produces data-informed recommendations for preventing pregnancy-related deaths.

Key Definitions

Maternal mortality (or maternal death):

Death of a woman while pregnant or within 42 days of termination of pregnancy (i.e., livebirth, stillbirth, ectopic or molar pregnancy, spontaneous or elective abortion) from any cause related to, or aggravated by, the pregnancy or its management, but not from accidental or incidental causes.

The maternal mortality ratio (MMR) is a standard indicator used by the World Health Organization (WHO) and the National Center for Health Statistics (NCHS) to measure trends in maternal deaths at the state, national, and international levels. MMR is calculated as the number of maternal deaths per 100,000 live births.

Pregnancy-associated death:

Death of a woman while pregnant or within one year of the end of a pregnancy (i.e., livebirth, stillbirth, ectopic or molar pregnancy, spontaneous or elective abortion) from any cause. Pregnancy-associated deaths are not necessarily pregnancy-related.

Pregnancy-related death:

Death of a woman while pregnant or within one year of the end of a pregnancy (i.e., livebirth, stillbirth, ectopic or molar pregnancy, spontaneous or elective abortion) from any cause related to, or aggravated by, the pregnancy or its management.