California Pregnancy-Associated Mortality Review ​(CA-PAMR)

Pregnancy-related mortality is a rare but tragic event for the families left behind and society as a whole. With the ultimate goal to eliminate preventable deaths related to or aggravated by pregnancy and associated racial/ethnic and health inequities, the California Pregnancy-Associated Mortality Review (CA-PAMR) was established to comprehensively review deaths among pregnant or recently pregnant Californians, up to one year after pregnancy. (For information on how these deaths are identified, visit CA-PMSS.)

Each death is examined through a health equity lens and discussions include how social determinants of health, discrimination and racism may have contributed to the death. Through detailed case reviews,  CA-PAMR's multidisciplinary committees of clinical and community experts identify the underlying causes of deaths related to physiologic changes of pregnancy or from causes aggravated by pregnancy or its management (pregnancy-related deaths); uncover contributing factors; determine quality improvement opportunities at the patient, provider, facility, system and community levels; and make actionable data-informed recommendations for preventing pregnancy-related deaths and optimizing maternal health outcomes and experiences equitably for all women and birthing people.

The Maternal, Child and Adolescent Health (MCAH) Division established CA-PAMR in 2006 following a dramatic rise in maternal mortality. CA-PAMR is a collaboration between MCAH and its contracting partners at Stanford University's California Maternal Quality Care Collaborative (CMQCC), the Public Health Institute (PHI) and Cedars-Sinai Medical Center.

Current Reviews

Statewide Review of Obstetric Hemorrhage Deaths, 2014-2018

This focused-topic review is examining deaths due to obstetric hemorrhage in 2014-2018.

Southern California Pregnancy-Associated Mortality Review, 2019-ongoing

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. This region was defined based on the annual number of pregnancy-related deaths, sociodemographic diversity, systems of care, and geographic proximity of the counties.

Planned Reviews

Statewide Review of Deaths from COVID-19, 2020-2021+

This focused review will examine deaths due to COVID-19 to provide insights for prevention of future deaths from novel infection during a pandemic.​​

Past Reviews

Statewide Review of Pregnancy-Associated Suicide, 2002-2012

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This focused-topic review examined 99 deaths from suicide in 2002-2012 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.

Statewide Review of Obstetric/Medical Deaths, 2002-2007

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This six-year statewide review examined 333 pregnancy-related deaths due to obstetric and medical causes in 2002-2007 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.