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Maternal Mortality and the California Pregnancy-Associated Mortality Review (CA-PAMR)

MO-07-0132 CA-PAMR

The California Pregnancy-Associated Mortality Review (CA-PAMR) is a project of the California Department of Public Health (CDPH), Maternal, Child and Adolescent Health (MCAH) Program in collaboration with the California Maternal Quality Care Collaborative (CMQCC) and the Public Health Institute (PHI). CA-PAMR serves to determine the causes of maternal mortality and to make recommendations concerning quality improvement opportunities in maternity care and public health strategies to prevent maternal deaths in California. CDPH/MCAH and the CA-PAMR project are fortunate to have the voluntary service of the CA-PAMR Committee, a statewide, multidisciplinary Committee comprised of leading clinical experts in maternal and perinatal health and public health.  


  • CA-PAMR seeks to strengthen California’s surveillance of maternal mortality and to determine its causes on order to identify public health and clinical interventions to reduce maternal mortality and associated racial/ethnic disparities.


Program Activities

  • CA-PAMR was established in 2006 and reviewed maternal deaths from 2002  to 2007, the years with the sharpest rise in maternal mortality.
  • CA-PAMR consists of four components:
    1. Enhanced surveillance of pregnancy-associated deaths by MCAH through the linkage of birth certificates with maternal and fetal death certificates and hospital discharge data. CA-PAMR identifies women who died within one year of having a live birth or fetal death;
    2. Collection and abstraction of medical records by the Public Health Institute for deaths that are likely or known to be pregnancy-related;
    3. Case review by the multidisciplinary CA-PAMR Committee  to determine whether deaths are pregnancy-related, causation, factors that contributed to the deaths and recommendations for improvements in maternity care;
    4. Translation of findings into maternal health quality improvement initiatives by the California Maternal Quality Care Collaborative targeted to obstetric care providers, maternity units, and local health departments that provide direct care to pregnant and postpartum women.
  • Findings to date are published in a CDPH report and peer reviewed publications (see below). 


  • Maternal Mortality: Definition, Trends, and Race and Age Stratifications, 1999-2013 
  • Maternal Mortality Rates for U.S. and CA, 1999-2013
  • Publications and Reports

  • MCAH Bulletin: California Maternal Morbidity Rates, 1999-2013
  • Pregnancy-Related Cardiovascular Deaths in California: Beyond Peripartum Cardiomyopathy 
  • Pregnancy-Related Mortality in California: Causes, Characteristics, and Improvement Opportunities
  • CA-PAMR Mixed Methods Approach for Improved Case Identification, Cause of Death Analysis and Translation of Findings
  • The California Pregnancy-Associated Mortality Review (CA-PAMR), Update  from 2002 - 2004 Maternal Death Reviews (PDF, 1.1 MB)
  • CA-PAMR Public Use Slide Set: 2002-2004 (PDF)
  • The California Pregnancy-Associated Mortality Review, Report from 2002 and 2003 Maternal Death Reviews (PDF, 1.1 MB)
  • CA-PAMR Report Public Use Slide Set: 2002-2003 (PDF)   
    • Who Benefits

      • All women of childbearing age and their families, but especially pregnant and postpartum women


      • Federal Title V MCH Block Grant Funds.  CDPH MCAH Program administers CA-PAMR.


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      Last modified on: 7/21/2016 2:53 PM