Begun in 2006, the California Pregnancy-Associated Mortality Review (CA-PAMR) is co-convened by the Maternal, Child and Adolescent Health Division of the California Department of Public Health, the Public Health Institute and CMQCC. This work has produced three reports, several peer-reviewed journal articles and provided the rationale for maternal quality toolkits that transformed the improvement opportunities into implementation efforts to better care for pregnant and postpartum women who experience obstetric hemorrhage, hypertensive disorders of pregnancy, venous thromboembolism, sepsis, and cardiovascular disease.
In 2024, there are three reviews in process, with volunteer committees composed of clinicians and community members selected for their expertise, representativeness, and commitment to eliminating preventable maternal mortality and racial inequities.
Pregnancy-Associated Mortality Surveillance System (PMSS), 2008-Present
A small subset of reviewers from the 2002-2007 CA-PAMR report reviewed > 500 cases of deaths occurring to women within one year of pregnancy to determine pregnancy-relatedness and cause of death. The project produced a report on pregnancy-related deaths that occurred between 2008-2016. The CA-PMSS committee team is reviewing deaths in near real-time.
Findings up to 2021 from this review are available at the California pregnancy-related mortality dashboard from the California Department of Public Health, Maternal, Child and Adolescent Health Division. Here you will find state-level data for 2009-2021 at a glance, obtain more details for indicator subcategories, as well as download data for your own analyses.
Southern California Pregnancy-Associated Review Committee, 2019-Present
Funded by grants from the CDC-ERASE program, the SoCAL PARC reviews maternal deaths in Los Angeles, Orange, Riverside, San Bernardino, San Diego and Imperial counties from 2019 – current. The project began reviewing cases in December 2020 and includes a new data collection tool which incorporates perspectives on social determinants of health and the role that discrimination/bias contributes to maternal deaths. The SoCAL PARC also determines preventability and identifies opportunities for improvement and prevention. The CDPH-MCAH reports the SoCAL PARC data to the CDC to aid that agency’s work understanding the drivers of maternal mortality, plus associated disparities, on a national level, and developing guidance on the implementation of interventions in communities where the need is most significant. Learn more about how the CDC supports maternal mortality review committees (MMRCs) at the Review to Action website.
Central Valley Pregnancy-Associated Review Committee, 2024-Present
California has launched a California Pregnancy-Associated Review Committee (CA-PARC) in the Central Valley counties of Butte, Colusa, Glenn, Fresno, Kern, Kings, Madera, Merced, Placer, San Joaquin, Sacramento, Shasta, Stanislaus, Sutter, Tehama, Tulare, Yolo and Yuba.
Active reviews have ended, and data analysis is underway:
Focused Statewide Review of Obstetric Hemorrhage Deaths, 2014-2018
This review examined cause of death and identified quality improvement opportunities among the cases of women who died from hemorrhage. As of 5/13/2022, the committee reviews and data analysis are complete. A manuscript to be submitted to peer-reviewed journal is undergoing approvals at CDPH.
Focused Statewide Review of Maternal Deaths due to COVID-19, 2020-2022
This review examined maternal deaths from COVID which occurred between 2020 and 2022. Data analysis is underway, and the team plans to disseminate the findings in a timely way.
Funding Acknowledgement
CA-PAMR is supported by a federal Title V Maternal and Child Health block grant from the Maternal, Child and Adolescent Health Division of the California Department of Public Health.
Reports and Publications
2008-2016 California Pregnancy-Related Deaths Report
2002-2007 Maternal Death Reviews
2002-2012 Pregnancy-Associated Suicide
Morton CH, Van Otterloo LR, Seacrist MJ, and EK Main. Translating maternal mortality reviews into action: QI opportunities among leading causes of pregnancy-related deaths in California. Journal of Obstetric, Gynecologic and Neonatal Nursing. 2019.
Morton CH, Seacrist MJ, Van Otterloo LR, and EK Main. QI Opportunities Identified Through Case Review of Pregnancy-Related Deaths from Preeclampsia. Journal of Obstetric, Gynecologic and Neonatal Nursing. 2019
Seacrist MJ, Morton CH, Van Otterloo LR, and EK Main. QI Opportunities Identified Through Case Review of Pregnancy-Related Deaths from Sepsis. Journal of Obstetric, Gynecologic and Neonatal Nursing. 2019
Seacrist MJ, Van Otterloo LR, Morton CH and EK Main. QI Opportunities Identified Through Case Review of Pregnancy-Related Deaths from Obstetric Hemorrhage. Journal of Obstetric, Gynecologic and Neonatal Nursing. 2019
Van Otterloo LR, Seacrist MJ, Morton CH and EK Main. QI Opportunities Identified Through Case Review of Pregnancy-Related Deaths from Venous Thromboembolism. Journal of Obstetric, Gynecologic and Neonatal Nursing. 2019
Van Otterloo LR, Morton CH, Seacrist MJ, and EK Main. QI Opportunities Identified Through Case Review of Pregnancy-Related Deaths from Cardiovascular Disease. Journal of Obstetric, Gynecologic and Neonatal Nursing. 2019
Judy AE, McCain CL, Lawton ES, Morton CH, Main EK, Druzin ML. Confirming the paradigm shift: systolic hypertension and preeclampsia-related mortality in California. Obstetrics & Gynecology. Vol. 133, No. 6, June, pp.1151-1159. 2019
Hameed A, Lawton E, McCain C, Morton CH, Mitchell C, Main EK and Foster E. Pregnancy-related cardiovascular deaths in California: Beyond peripartum cardiomyopathy. American Journal of Obstetrics and Gynecology. 2015
Main EK, McCain CL, Morton CH, Holtby S, and ES Lawton. Pregnancy-related mortality in California: Causes, characteristics and improvement opportunities. Obstetrics and Gynecology. 2015
Mitchell C, Lawton E, Morton CH, McCain C, Holtby S, EK Main. California Pregnancy-Associated Mortality Review: Mixed methods approach for improved case identification, cause of death analyses and translation of findings. Maternal Child Health Journal. 2013