Pregnancy Associated Mortality Review

Pregnancy Associated Mortality Review (PAMR) collects data regarding all reported deaths that are causally related to pregnancy. The first step is to identify all deaths occurring during pregnancy or within one year of pregnancy. Methods used to establish this temporal relationship between pregnancy and a death include: 1) a pregnancy check box has been marked on the death certificate, 2) the death certificate indicates that the woman was pregnant at the time of death, or 3) the death certificate of the reproductive-aged woman has been matched with a birth certificate or fetal death certificate for a delivery that occurred within one year before the woman's death.

The Section of Epidemiology for Public Health Practice (EPHP) provides the Bureau of Genetics and Healthy Childhood with copies of death certificates that were causally related to pregnancy. For deaths that occurred after a live birth or stillbirth, the matching birth or fetal death certificates are also provided by EPHP. In addition to requesting certificates of deaths that are causally related to pregnancy, EPHP also sends certificates of all deaths that occurred during pregnancy or within one year of pregnancy, regardless of the cause of death or relation between pregnancy and the death.

Data are coded after abstraction of all available information from death certificates (including notes written in the margins of death certificates), medical records, autopsy reports, and matched birth and fetal death certificates. Data concerning all deaths are reviewed and classified by the Pregnancy Associated Mortality Review Board regarding the immediate and underlying cause of death, associated obstetric conditions, and the outcome of the pregnancy.

A woman's death is classified as pregnancy-related if it occurred during pregnancy or within one year of pregnancy and resulted from: 1) complications of the pregnancy, 2) a chain of events that was initiated by the pregnancy, or 3) the aggravation of an unrelated condition by the physiologic effects of the pregnancy or its management.