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Pregnancy Associated Mortality Review (PAMR) Activities

HRSA State Maternal Health Innovation Program

ODH was awarded $2 million/year for the next 5 years, for a total of ~$10 million to support maternal mortality prevention efforts (9/30/2019 – 9/29/2024). ODH is one of 9 awardees.

With support from this funding, the PAMR will build on the existing program and infrastructure to mobilize data-to-action efforts by:

  1. establishing a state-focused Maternal Health Task Force to create and implement a strategic plan to prevent and reduce preventable maternal deaths;
  2. improving the collection, analysis, and application of state-level data on maternal mortality and severe maternal morbidity; and
  3. promoting and executing innovation in maternal health service delivery (e.g., widespread implementation of maternal safety efforts, assuring risk appropriate care, etc.).

Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM)

ODH was awarded $2,250,000 over 5 years (9/30/2019 – 9/29/2024) from CDC for the Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM) Program. ODH is one of 24 awardees. This funding will directly support agencies and organizations that coordinate and manage Maternal Mortality Review Committees to identify, review, and characterize maternal deaths; and identify prevention opportunities. Through this work, CDC aims to do the following:

  • Leverage collaborative partnerships to inform practice and policy changes and to facilitate an understanding of the drivers of maternal mortality and complications of pregnancy, and better understand the associated disparities.
  • Determine what interventions at patient, provider, facility, system, and community levels will have the most impact.
  • Implement initiatives in the right places for families and communities who need them most.

Rapid Maternal Overdose Response

Through the CDC Building Capacity to Review and Prevent Maternal Deaths Initiative, Ohio has joined 6 other states with maternal mortality review committees, in a CDC Foundation funded opportunity to review all pregnancy-associated overdose deaths. Activities will be based on four, specific strategies: 1) the comprehensive review of all pregnancy-associated overdose deaths; 2) the timely and effective use of maternal mortality review committee overdose death findings; 3) enhancing and expanding maternal mortality review committee partnerships and networks with CDC, stakeholders and other jurisdiction-based maternal mortality review committees; and 4) improving the understanding of opiate use and misuse during pregnancy. Funding is expected through 9/29/2020.

Obstetric Emergency Simulation Project

Ohio was one of six states selected to participate in the "Every Mother Initiative" (EMI), an action learning collaborative funded by Merck for Mothers and operated by the Association of Maternal Child Health Programs (AMCHP).

​Birthing Simulator

In 2014, ODH and The Ohio State University (OSU) partnered together to launch PAMR’s first initiative. Staff primarily from labor and delivery and postpartum units in three rural Ohio communities gained hands-on experiences in obstetric emergency situations using the high-tech mannequin SimMom.

SimMom is a highly advanced full body birthing simulator with accurate anatomy and functionality. Participants were able to check SimMom’s vitals and administer medications, as well as treat her for the following obstetric emergencies:

  • Postpartum Hemorrhage
  • Cardiomyopathy
  • Preeclampsia

Training Results

A total of 122 health care professionals across 14 Ohio hospitals participated in the training. Participants improved knowledge of obstetric complications and confidence in managing obstetric emergencies. A more in-depth training for OB clinical and nurse educators was held at the Ohio State University in October 2015 with funding from the Maternal and Child Health Block Grant through ODH.

Data Management

Identification of Maternal Deaths/Quality Improvement for Vital Statistics

Identification of maternal deaths and accurately counting maternal deaths is the first step of the review process.  Ohio was one of four states invited to participate in a quality improvement collaborative by the CDC designed to identify solutions for improving accuracy of the pregnancy checkbox on death certificates. Monthly, the ODH Bureau of Vital Statistics staff performed a linkage between 2016 death certificates for women who died with a positive maternal checkbox and any live birth certificate or fetal death certificate issues within 365 days of each woman’s death. Women with a positive maternal checkbox should have a linkage and if so, would be a considered confirmed maternal death. If no linkage was identified, vital statistics staff queried local certifiers to either confirm (true positives) or disconfirm (false positives) pregnancy. If not confirmed, local certifiers were then asked to file an amended death certificate to correct any errors. Significantly more false negatives than false positives were identified. These certificates were successfully corrected. This on-going process leads to accurate state statistics for reporting maternal deaths to stakeholders and to national agencies and databases. From a PAMR standpoint, identification of false positives saves time for staff as they will not receive false positive records and spend unnecessary time requesting records for these cases. In addition, the pregnancy-associated death rate and number of cases for review will be available at least a year earlier.


One of the key needs of mortality review is the ability to analyze the data obtained. Ohio partnered with CDC in developing a national database for maternal deaths by serving as a beta testing site during 2014-2016, and sharing review tools and process.

The Maternal Mortality Review Information Application (MMRIA) provides a system for case abstraction and logging committee decisions as well as providing data in a format ready for analysis. The national system gives a common language for maternal mortality review committees like PAMR across the country, allowing for comparisons among states and aggregation of data. Following beta-testing from 2014-2016, Ohio fully adopted this system in 2017.