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Maternal, Child and Adolescent Health Division

California Pregnancy-Associated Mortality Review (CA-PAMR)

women consulting health care professional

The death of a pregnant or recently pregnant person is a rare but tragic event for the families and communities left behind, and society as a whole. In California, around 70 pregnant and birthing people die annually from pregnancy or childbirth complications. Sadly, many of these deaths are preventable.

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.”

In 2006, the California Department of Public Health’s Maternal, Child and Adolescent Health Division (MCAH) established the California Pregnancy-Associated Mortality Review (CA-PAMR) to comprehensively review deaths among pregnant or recently pregnant Californians, up to one year after pregnancy. Each death is examined through a health equity lens and considerations 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

  • determine the underlying causes of pregnancy-related deaths;
  • identify contributing factors at the individual/family, provider, facility, system and community levels;
  • discuss quality improvement and preventive strategies at the individual/family, provider, facility, system and community levels and preventability; and
  • make actionable data-informed recommendations for preventing pregnancy-related deaths and optimizing maternal health outcomes and experiences equitably for all pregnant and birthing people.

The ultimate goal of CA-PAMR is to eliminate preventable pregnancy-related deaths and associated health inequities. (For information on how these deaths are identified and tracked, visit CA-PMSS.)

CA-PAMR is a collaboration between MCAH, its contracting partners at Stanford University's California Maternal Quality Care Collaborative (CMQCC) and the Public Health Institute (PHI), and its multidisciplinary expert committees.

Current Reviews

Statewide Review of Obstetric Hemorrhage Deaths, 2014-2018 

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

Statewide Review of COVID-19 Deaths, 2020-2022 

This focused-topic review is examining Covid-19 deaths suspected to be related to pregnancy in 2020-2022.

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.​

Past Reviews

Funding

Reviews of obstetric hemorrhage deaths and deaths from COVID-19 are supported by the Health Resources and Services Administration (HRSA) Title V Maternal Child Health Block Grant. Reviews of deaths in Southern California are supported with grant funding from the Centers for Disease Control and Prevention (CDC)’s Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM) Program. Past death reviews of obstetric/medical causes in 2002-2007 and pregnancy-associated suicide in 2002–2012 were supported by the HRSA Title V Maternal Child Health Block Grant.​

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