California Pregnancy-Associated Mortality Review (CA-PAMR)

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, 2014–18 

This focused-topic review is examining deaths due to obstetric hemorrhage in 2014–18.

Statewide Review of COVID-19 Deaths, 2020–22 

This focused-topic review is examining Covid-19 deaths suspected to be related to pregnancy in 2020–22.

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

Statewide Review of Pregnancy-Associated Suicide, 2002-2012

Read report (PDF, 20MB)

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.

Statewide Review of Obstetric/Medical Deaths, 2002-2007

Read report (PDF, 6MB)

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.