California's Maternal Mortality Review: Methods and Summary Findings

The California Pregnancy-Associated Mortality Review (CA-PAMR) began in 2004 in response to rising rates of maternal mortality and associated racial disparities. California's maternal mortality rate in 2006 was 19.2 per 100,000 live births, more than four times the Healthy People 2010 objective of 4.3 per 100,000 live births and higher than the national rate in 2005 of 15.1. In California, African-American women are more than 3 times as likely as White women to die from pregnancy-related causes (54.9 per 100,000 live births vs. 16.8 respectively). The CA-PAMR identified 194 women in 2002 who died during pregnancy or within one year of a live birth or fetal death. Data from medical and coroner records were abstracted for all pregnancy-related deaths and a sample of non-related deaths (n=75). Case summaries were reviewed by a multidisciplinary committee to determine the factors contributing to the death, and to identify opportunities for quality improvement. Among the pregnancy-related cases, the leading causes of death were cardiovascular conditions, which accounted for half of the deaths, followed by amniotic fluid embolism and hemorrhage. About 30% of the women were obese (BMI>30) and 23% were overweight (BMI 25-30.0). They were more likely than the general population of women who gave birth in CA to be unmarried (40% vs. 31% respectively) and to have had their deliveries paid for by Medi-Cal (57% vs. 43%). It is anticipated that this and other data from CA-PAMR will inform maternal health policy in California.