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Pregnancy-Associated Mortality Review (PAMR)

doctorsThe Ohio Department of Health (ODH) established the Pregnancy Associated Mortality Review (PAMR) in 2010 to identify and review all pregnancy-associated deaths in Ohio with the goal of developing effective interventions to reduce maternal mortality.

The ODH ‘s Office of Vital Statistics obtains death certificates of all maternal deaths that occurred two years prior. For example, the first review in 2010 only looked at deaths that occurred in 2008.


Deaths qualify for review by meeting all of the following criteria:    

  • Pregnancy-associated death  

  • Ohio resident  

  • Death occurred in Ohio



How Does Ohio PAMR Work?

Step 1 - Identify Maternal Deaths

Ohio PAMR identifies maternal deaths through death certificates, ICD-10 obstetric cause of death codes, and linkage to live birth or fetal death certificates. Ohio requires mandatory reporting of all deaths which occur in maternity units.

Ohio PAMR uses the following definitions of maternal death adopted by the Maternal Mortality Study Group of the American College of Obstetricians and Gynecologists (ACOG) and the Centers for Disease Control and Prevention (CDC):

  • Pregnancy-associated death1: The death of a woman while pregnant or anytime within one year of pregnancy regardless of cause.

  • Pregnancy-related death1: The death of a woman while pregnant or within one year of pregnancy from any cause related to or aggravated by the pregnancy or management, excluding accidental or incidental causes.

Step 2 - Data Collection

documentsThe PAMR coordinator may request records from the following sources in order to gain a more comprehensive understanding of the circumstances leading up to the death:

  • Hospitals

  • Coroners

  • Physicians

  • Law Enforcement Agencies

  • Vital Statistics

  • Emergency Medical Services

  • Mental Health Records (if available)

Step 3 - Data Abstraction

The PAMR coordinator abstracts the information collected from records to create a de-identified case summary.


Step 4 - Case Review

Case summaries are reviewed three times a year by an external volunteer committee of diverse health-related disciplines including :

  • OB/GYN, Midwifery

  • Maternal Fetal Medicine

  • Mental Health (including experts in intimate partner violence and human trafficking)

  • Anesthesiology

  • Epidemiology

  • Ohio Coroners’ Association

  • State and Local Health Departments

  • Legal Services including Risk Management

  • Social Work

  • Hospital Administration

Members review 20 - 24 cases per meeting where they discuss the case and complete the following:

    • Determine if death was pregnancy-related

    • Determine agreement on cause and manner of death listed on death certificate

    • Identify risk factors, barriers, gaps, needs, and areas for improvement

    • Gauge level of opportunity to alter outcome

 

Step 5 - Recommendations and Interventions

After review, maternal mortality data are analyzed.  For more information on PAMR initiatives go HERE.


Program Contact:

Cynthia Shellhaas, MD, MPH
Email: cynthia.shellhaas@odh.ohio.gov

Last Updated: 11/24/15