California Pregnancy-Associated Mortality Review (CA-PAMR)
When Pregnancy-Related Deaths Occur and Why They Matter
The death of a pregnant or recently pregnant person is a rare yet tragic event for the families, communities and society. In California, around 70 pregnant and birthing people die each year from pregnancy or childbirth complications. Sadly, many of these deaths could be prevented.
The Centers for Disease Control and Prevention defines a pregnancy-related death as “the death of a woman during pregnancy or within one year of the end of pregnancy from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy."
About CA-PAMR
In 2006, the California Department of Public Health (CDPH) established CA-PAMR — now part of the
California Pregnancy-Associated Review Committee (CA-PARC) — to review deaths of pregnant or recently pregnant Californians within one year after pregnancy. Each death is examined using a health equity framework, considering factors like social determinants of health, discrimination, and racism. (For information on how these deaths are identified and tracked, visit
California Pregnancy Mortality Surveillance System (CA-PMSS).)
Through detailed case reviews, CA-PAMR’s committees of clinical and community experts:
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examine the causes of pregnancy-related deaths, including the events that initiated the chain of problems leading to the death;
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identify factors that may have contributed, including those related to individuals and families, healthcare providers and facilities, systems and policies, and community characteristics;
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discuss ways to improve quality of care and prevent future deaths across these same levels; and
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develop clear, data-informed recommendations to prevent pregnancy-related deaths and support safe, respectful and equitable care for all birthing people.
CA-PAMR works to end preventable pregnancy-related deaths and close health gaps by providing clear data on the causes and drivers of these deaths, sharing findings with partners across many sectors, and working with implementation partners to support meaningful change.
CA-PAMR is a collaboration between the California Department of Public Health (CDPH), Stanford University's California Maternal Quality Care Collaborative (CMQCC), the Public Health Institute (PHI), and its expert committees.
Current Reviews
This is a regional, population-based review of all deaths suspected to be medically related to pregnancy that occurred in the 18 counties making up the Central Valley region: Butte, Colusa, Glenn, Fresno, Kern, Kings, Madera, Merced, Placer, San Joaquin, Sacramento, Shasta, Stanislaus, Sutter, Tehama, Tulare, Yolo, and Yuba beginning in 2023. This region was selected to examine the specific factors affecting maternal health outcomes in rural communities within California.
This is a regional, population-based review of all deaths suspected to be medically related to pregnancy that occurred in Los Angeles, Orange, Riverside, and San Bernardino counties beginning in 2019. The review has been expanded to include San Diego and Imperial counties for deaths starting in 2023. This region was defined based on the annual number of pregnancy-related deaths, sociodemographic diversity, systems of care, and geographic proximity of the counties. The committee's findings and recommendations from the review of 68 pregnancy-related deaths in 2019-2021, excluding those related to COVID-19, will be available soon.
Past Reviews
The COVID-19 Pregnancy-Associated Mortality Review Committee convened during 2022-2024 to review all suspected pregnancy-related COVID-19 deaths in California from 2020-2022. This review identified 58 pregnancy-related deaths attributed to COVID-19 infection. The committee's findings and recommendations will be available soon.
The Obstetric Hemorrhage Pregnancy-Associated Mortality Review Committee convened during 2020-2022 to review all deaths due to obstetric hemorrhage (excessive bleeding during pregnancy, childbirth, or postpartum) in California from 2014-2018. This review identified 49 deaths resulting from obstetric hemorrhage, with primary causes including placenta accreta spectrum, intra-abdominal bleeding, uterine atony, and ruptured ectopic pregnancy. The committee concluded that 63% of these deaths could likely have been prevented, with some causes – such as uterine atony and intra-abdominal bleeding – being more preventable than others. Improving preconception health and using system-based strategies for hemorrhage preparedness, detection, and clinical management are key to reducing deaths from hemorrhage, especially when patients do not improve with first-line treatment.
Findings from this review were published in February 2025 in
Obstetrics & Gynecology:
Krakowiak P, Morton CH, et al. Pregnancy-Related Mortality in California Due to Obstetric Hemorrhage. Obstet Gynecol. 2025 Feb 13. doi: 10.1097/AOG.0000000000005847.
Factsheets summarizing the key findings and prevention recommendations for Agencies, Organizations, and Institutions, and for Clinicians, Facilities, and Healthcare Systems will be available soon.
This focused-topic review examined 99 deaths from suicide in 2002–12 among women who died while pregnant or within a year of the end of pregnancy. These in-depth reviews revealed that half of the pregnancy-associated deaths by suicide had a good-to-strong chance of being prevented with missed opportunities to intervene, and nearly all had at least some chance of being prevented. Overarching themes for alternative approaches to the recognition, diagnosis, treatment or follow-up included (1) screening for mental health conditions, adverse childhood experiences, intimate partner violence during and after pregnancy; (2) improving coordination of obstetric care with psychiatry and mental health treatment; (3) availability of adequate pregnancy and postpartum care and supports related to pregnancy loss or removal of child from mother; and (4) providing partners and family members with linguistically and culturally appropriate information and support regarding their loved one’s mental health condition. Findings and recommendations from this review were published in a report released in 2019.
This six-year statewide review examined 333 pregnancy-related deaths due to obstetric and medical causes in 2002–07 to improve maternity care and maternal health outcomes. The reviews revealed that (1) two-fifths of pregnancy-related deaths had a good-to-strong chance of being prevented; (2) cardiovascular disease was the leading cause of death; (3) the risk of pregnancy-related deaths for Black women was three-to-four times higher than those of Asian/Pacific Islander, Hispanic/Latina and White women; and (4) multiple patient, provider and facility factors contributed to pregnancy-related deaths. Quality improvement opportunities for both providers and hospital facilities included implementation of standardized protocols, effective planning and better communication, and appropriate use of obstetric procedures. Findings and recommendations from this review were published in a report released in 2018.
Funding
The current reviews are funded by the Health Resources and Services Administration (HRSA) Title V Maternal Child Health Block Grant, a grant from the Centers for Disease Control and Prevention (CDC) Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM) Program, and the State General Fund. Reviews of deaths in Southern California are primarily supported with grant funding from the CDC ERASE MM Program. Previous reviews of pregnancy-related deaths from COVID-19 in 2020–2022, obstetric hemorrhage deaths in 2014-2018, pregnancy-associated suicide in 2002-2012, and obstetric/medical causes in 2002–2007 were exclusively supported by the HRSA Title V Maternal Child Health Block Grant.