Pregnancy-Associated Mortality Review (PAMR)
The Pregnancy-Associated Mortality Review program is designed to improve data collection and reporting of maternal deaths in Missouri. The PAMR board is comprised of a diverse list of health care experts and reviews all maternal deaths that occur while a woman is pregnant, or within one year of the end of her pregnancy.
Goal: to reduce preventable maternal mortality in Missouri
The PAMR board and program exist to better understand the factors that contribute to or cause maternal deaths, and prevent future occurrences through recommendations made by the PAMR board.
Key Insights
- Annually, an average of 70 Missouri women die while pregnant or within one year of pregnancy.
- 84% of pregnancy-related deaths were determined to be preventable.
- Mental health conditions were the lead underlying cause of pregnancy-related deaths, followed by
cardiovascular disease and then homicides.
Improving data collection and dissemination
The PAMR program prioritized data gathering and dissemination, resulting in a first-of-its-kind interactive dashboard.
Key Definitions
The PAMR board analyzes all maternal deaths that occur while a woman is pregnant, or within one year of the end of pregnancy. Those cases are considered pregnancy-associated deaths, but not all are determined to be pregnancy-related deaths.
Maternal Mortality
The PAMR program uses the term maternal mortality to encompass the topic of deaths during pregnancy, childbirth, and the postpartum period up to 365 days from the end of pregnancy.
Maternal Death
The death of a woman while pregnant or within 42 days of termination of pregnancy, regardless of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental causes. This definition is used by the National Center for Health Statistics and the World Health Organization.
Implementation and Improvement
The PAMR program has continued to work toward the improvement of data gathering and dissemination. To that end, the program has worked to expand the identification techniques used to enhance case identification. Additionally, the program has greatly increased its dissemination capabilities through fostering partnerships and expanding tools available for this task, such as the development of an interactive data dashboard. The program has also worked with partners to improve timeliness and to enhance the information available to the board through the abstraction process, particularly with regard to SDOH.
Summary of Major Accomplishments
The following accomplishments occurred in 2022 and the first half of 2023:
- Expanded PAMR case identification techniques to be more comprehensive and improve timeliness of case identification.
- Developed and published a public data dashboard reporting on pregnancy-associated deaths at https://health.mo.gov/data/pamr/dashboard.php.
- Completed 44 different dissemination activities on maternal mortality, including dissemination of an infographic through social media on Jan. 23 to mark Maternal Health Awareness Day.
- Presented a poster of PAMR data at PQC conventioning and presented at the annual Association of Maternal and Child Health Programs conference titled "Polysubstance Abuse: A Pervasive Threat to Maternal Health in Missouri".
- Continued contracting with the Missouri Hospital Association on maternal mortality prevention efforts, including caring for the mother-baby dyad affected by substance use, severe hypertension in pregnancy and obstetric hemorrhage.
- Shared aggregate PAMR data as part of CDC’s Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees in 36 US States, 2017-2019 brief.
Definitions
Maternal death
The death of a woman while pregnant or within 42 days of termination of pregnancy, regardless of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental causes. This definition is used by the National Center for Health Statistics and the World Health Organization.
Pregnancy-associated death (PA)
A death during or within one year of pregnancy, regardless of the cause. These deaths make up the universe of maternal mortality; within that universe are pregnancy-related deaths and pregnancy-associated, but not related deaths.
Pregnancy-related death (PR)
A death during or within one year 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.
Pregnancy-associated, but not related death (PANR)
A death during or within one year of pregnancy, from a cause that is not related to pregnancy.
Maternal Mortality
The PAMR program uses the term maternal mortality to encompass the topic of deaths during pregnancy, childbirth, and the postpartum period up to 365 days from the end of pregnancy.
Pregnancy Resources for Moms
DHSS Links
Department of Social Services Links
Federal Links
Additional Links
Resources for Providers
Partner Links
Federal Links
- CDC
- Maternal Early Warning Signs (MEWS) Protocol developed by the former Council on Patient Safety in Women’s Health Care.
- SPEAK UP Program by the Institute for Perinatal Quality Improvement.
Video: A Physician Shares Stories about Listening to Black Women - Cardiovascular Disease in Pregnant and Postpartum Women
- CVD Assessment Algorithm
- B-Type Natriuretic Peptide (BNP)
- Resources When Caring For Women With Adult Congenital Heart Disease or Other Forms of Cardiovascular Disease
- Maternal Risks For Underlying Cardiovascular Disease: Key Consensus Tables
- Guide to Cardiovascular Disease Medications for Pregnancy and Breastfeeding Women
- Guide to Contraception Information for Women with Cardiovascular Disease
- Review to Action
- SAMHSA
- Additional Links
Pregnancy Resources for Moms
Resources for Providers
Contact
Office on Women's Health
Missouri Department of Health and Senior Services
PO Box 570
Jefferson City, MO 65102-0570
Telephone: 573-526-0445
Email: womenshealth@health.mo.gov
