PAMR enters and stores all case data in Maternal Mortality Review Information Application (MMRIA), a comprehensive database provided by the Centers for Disease Control and Prevention (CDC) to all state maternal mortality review committees. MMRIA supports a common language for review committees, and standardized documentation.
PAMR nurse abstractors enter information from a variety of sources into MMRIA, including:
- maternal death certificate
- autopsy report
- birth certificate or fetal death certificate
- prenatal records
- mental health records
- hospital records
- emergency department visits
- medical transport records (paramedics, emergency medical technicians)
- law enforcement records
Abstractors synthesize information from all available sources to create a case narrative, a summary of the circumstances surrounding the death. Case summaries are reviewed by the interdisciplinary PAMR Board, as outlined in HB166 Section 3738.03, which completes the committee decisions form, a standardized documentation tool provided by CDC Review to Action, and captures the decisions of the committee, including pregnancy-relatedness, cause of death, preventability, contributing factors to the death, and recommendations that address contributing factors. After review, committee decisions form data are entered into MMRIA for analysis.
PAMR analyzes data extracted from MMRIA to identify themes, underlying risk factors, and gaps in care. The following variables are routinely analyzed to describe pregnancy-associated deaths:
- age at death
- race and ethnicity
- insurance status
- marital status
- county type of maternal residence
- timing of death in relation to pregnancy
- causes of death.
Based on the analysis, PAMR makes recommendations for systems change to reduce maternal morbidity and preventable deaths, reduce disparities, and address health inequities.
Ohio and U.S. Pregnancy-Related Mortality Ratios (2008-2016)
Ohio Data Sources: Ohio Department of Health Pregnancy-Associated Mortality Review and Bureau of Vital Statistics.
U.S. Data Source: Centers for Disease Control and Prevention Pregnancy Mortality Surveillance System.
Note: U.S. and Ohio surveillance methods differ. Both include women who died during pregnancy or within one year of pregnancy. However, in contrast to the Ohio PAMR process, the U.S. process is based entirely on vital statistics data submitted to the CDC by states; medically trained epidemiologists determine the cause and time of death related to the pregnancy. More information on the U.S. system can be found at https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pmss.html.
Ohio Underlying Causes of Pregnancy-Related Deaths by Leading Causes (2008-2016)