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California Releases Pregnancy-Associated Mortality Review Findings (2002-2007)

An in-depth review of maternal deaths offers key insights to improve care and further reduce preventable maternal mortality

SACRAMENTO – Today, the California Department of Public Health (CDPH), the California Maternal Quality Care Collaborative (CMQCC) and Public Health Institute (PHI) announced the release of the Pregnancy-Associated Mortality Review, a comprehensive statewide examination of maternal deaths from 2002-2007. 

California has experienced a significant decline in maternal mortality, from a high of 16.9 deaths per 100,000 live births in 2006, to a low of 7.3 deaths per 100,000 in 2013. This is in contrast to the rest of the nation where maternal mortality rates are triple those of California.

The key findings of the Pregnancy-Associated Mortality Review include:

• Comprehensive data review revealed cardiovascular disease as the leading cause of pregnancy-related deaths during this study period. In contrast, analysis of death certificate information exclusively, would show pre-eclampsia, obstetric hemorrhage and amniotic fluid embolism as the leading causes of death.

• Racial disparities are clearly evident. The California Pregnancy-Associated Mortality Review (CA-PAMR) confirmed that while maternal mortality for African-American women showed the same 50 percent reduction, they continue to die at three-to-four times the maternal mortality rate of women of other racial/ethnicities groups, and as high as eight times the rate when deaths from pregnancy-related cardiovascular disease is considered.

• In most cases, multiple patient, facility, and health care provider factors contributed to the pregnancy-related deaths. Common factors included co-morbidities, especially obesity and hypertension, delayed recognition of and response to clinical warning signs, and a lack of institutional readiness for obstetric emergencies.

• Forty-one percent of the pregnancy-related deaths had a good-to-strong chance of preventability as determined by the expert review committee.

"California is actively working to promote the healthiest pregnancy and childbirth experience for women, and this report and its findings are a cornerstone for further reducing maternal deaths in the state," said CDPH Director and State Public Health Officer Dr. Karen Smith. "This includes reducing racial and ethnic disparities and optimizing women's health prior to pregnancy." 

The California Pregnancy-Associated Mortality Review was designed to inform and translate findings into strategies to reduce preventable maternal mortality and morbidity.

"The decline in maternal mortality in California likely reflects the collective impact of public health investments in maternal health programs, and the strong partnerships and commitment to improving maternal care by many individuals and organizations," stated Dr. Connie Mitchell, Deputy Director, Center for Family Health at the California Department of Public Health, and co- lead of the California Pregnancy-Associated Mortality Review. 

California is committed to maintaining the momentum toward improved maternal health outcomes for California women and their families. The findings from the Review can be applied to known areas for improvement, as well as to respond to other areas of need, such as maternal suicides and mental health issues among pregnant and postpartum women. 

"In the last decade, California hospitals have made significant strides in quality improvement for maternity care. We have come a long way, but we know we still have work to do. This in-depth analysis provides additional insights to inform ongoing improvements in care," stated Dr. Elliott Main, Chair of the California Maternal Quality Care Collaborative, and co-lead of the California Pregnancy-Associated Mortality Review.  

The Pregnancy-Associated Mortality Review is a statewide examination of maternal deaths using enhanced public health surveillance methodology and in-depth medical record review by an expert, multidisciplinary committee of maternity care and public health professionals. 

When the Review started in 2006, the goal was to study deaths that occurred during the period of the rise of maternal deaths.

Vital statistics and hospitalization data, which initiate the process to identify cases for review, are made available as full-year data sets, usually with approximately a two to three year lag-time to release.  Reviews of deaths from 2008-2013 are currently underway.

For more information about the Pregnancy-Associated Mortality Review, and to read the report, visit CDPH's website or CMQCC's website.