Maternal Mortality Review Team

Case Selection  | Record Review  | Confidentiality | Review Process | Membership | Additional Resources | Reports

Virginia's Maternal Mortality Review Team is dedicated to the identification of all deaths to women occurring during a pregnancy or within one year of a pregnancy and the development of recommendations to reduce preventable deaths in the Commonwealth. The Team reviews and analyzes maternal deaths in Virginia to develop an understanding of the causes of maternal death. We use the results to:

1. Educate colleagues and policymakers about these deaths and the need for changes in law and/or practice.
2. Recommend other improvements and interventions to reduce the number of preventable maternal deaths in Virginia

Maternal death review has been underway in the Commonwealth since 1928. Early efforts focused on natural maternal deaths and on review of medical records. This endeavor was a collaborative partnership between the Medical Society and the Virginia Department of Health. In 2001, maternal mortality review was restructured by the Virginia Department of Health (VDH) with support from the Centers for Disease Control and Prevention (CDC), the American College of Obstetricians and Gynecologists and the Medical Society of Virginia. Today, under a new partnership between the VDH Office of Family Health Services and the VDH Office of the Chief Medical Examiner, reviews have been expanded to include both natural and violent deaths (those resulting from homicide, suicide, and unintentional injury such as motor vehicle accidents).

For more information, contact Victoria Kavanaugh at: (804) 205-3853.

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Case Selection

The Maternal Mortality Review Team reviews all deaths to women occurring during a pregnancy or within one year of the termination of a pregnancy, regardless of the outcome of the pregnancy.  Cases  are identified in three ways: (1) through the International Classification of Diseases, Tenth Revision (ICD), those deaths identified on a death certificate with a cause of death in the "pregnancy, childbirth and puerperium" categories; (2) by matching birth certificates or fetal death certificates with maternal death certificate information; and/or (3) by selecting cases where the Commonwealth of Virginia death certificate indicates the decedent was pregnant within three months of her death.  This is a check box on Virginia's death certificate.

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Record Review

The Maternal Mortality Review Team Coordinator (Coordinator) requests medical records relevant to understanding the decedent's health; medical and social history; and events leading up to the fatal injury, illness or disease. The following medical records are typically requested and, if available, reviewed by the Coordinator in each maternal death:

• Prenatal Care
• Primary Health Care
• Hospital
• Emergency Department
• Medical Specialists
• Medical Examiner
• Mental Health

Where relevant, other public records such as court records or newspaper articles may also be collected.

The Coordinator organizes the records and prepares case summaries for Team Review. The summaries provide an overview of the decedent's background and social history, medical history, obstetrical history which includes prenatal care and labor and delivery for the most recent pregnancy, events leading up to the fatal event, and reports and investigations of the death itself.

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Confidentiality

Several steps are taken to insure the confidentiality of Team records and proceedings:

• Team meetings are closed and confidential
• All meeting attendees sign a sworn statement promising to maintain the confidentiality of information, records, discussions, and opinions disclosed during maternal mortality reviews.
• Names do not appear on documents presented to Team members for review. Team members receive materials and review de-identified cases at meetings and do not take these materials from the meeting.
• Review materials are collected and shredded at the end of each Team meeting.
• Summaries and reports on Team findings and recommendations provide patterns and trends in maternal death only and are presented in aggregrate form.

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Review

The Team typically meets six times per year in Richmond at the Office of the Chief Medical Examiner. Team discussions and deliberations are governed by these values:

• Multidisciplinary review which requires discussion and input from all health care and service systems designed to provide care and support to pregnant women and their families.
• A public health approach which emphasizes (1) the identification of indicators of maternal death; (2) descriptions of the populations of women at-risk for maternal death; (3) understanding the totality of factors impacting maternal deaths including medical, non-medical, law enforcement, legal and other social and economic factors; (4) the education of stakeholders in maternal health including women, policy makers, health care providers, and advocates for women's health and safety; (5) recognition of the policies and plans that support individual and community health efforts; and, most importantly, (6) the development of recommendations and interventions to reduce maternal deaths in the Commonwealth of Virginia.
• Retrospective review which permits the passage of time with regard to a fatal event which facilitates closure and complete death investigation. The Team reviews maternal deaths at least two years after the date of death.
• Consenus decision-making which honors the right of all persons in the group to express themselves in their own words.

Once a case has been reviewed, the Team works collaboratively to identify factors that may have contributed to the death and generates strategies for prevention and intervention. Among the factors that may be considered are availability and accessibility of services, transportation issues, mental illness such as perinatal depression, substance use and abuse, adequacy of patient education and referral and follow-up.

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Membership

Team members are recruited from among the following agencies and organizations and are asked to serve a term of three years.

State Professional Associations:

• American College of Nurse-Midwives, Virginia Chapter
• American College of Obstetricians and Gynecologists, Virginia Chapter
• Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN), Virginia Chapter
• Medical Society of Virginia
• National Black Nurses Association, Virginia Chapter
• Virginia Association of School Nurses
• National Association of Social Workers, Virginia Chapter
• Virginia Dietetic Association

Statewide Advocacy Organizations:

• Virginia Hospital and Healthcare Association
• Virginia Perinatal Association
• Virginia Sexual and Domestic Violence Action Alliance

Local Practitioners:

• Community Service Boards
• Local Health Departments
• Psychiatrists
• Regional Perinatal Councils
• Resource Mothers

State Programs:

• Virginia Department of Health
• Virginia Department of Mental Health, Mental Retardation and Substance Abuse Services
• Virginia Department of Social Services

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Additional Resources

The following websites provide information on maternal health:

International Resources:

• Safe Motherhood
• Unicef
• World Health Organization

National Resources :

• American Public Health Association's The Maternal and Child Health Community Leadership Institute
• Healthy People 2010
• National Center for Education in Maternal and Child Health
• U.S. Department of Health and Human Services (DHHS)
• Centers for Disease Control and Prevention (CDC)
• Pregnancy Related Illness
• Pregnancy Related Mortality Surveillance in the United States - 1991-1999
• Maternal and Child Health Bureau
• The Office of Women's Health

State Resources:

• Commonwealth of Virginia Department of Health: Office of Family Health Services (OFHS). Division of Women's and Infants Health, Virginia Department of Health

Reports

Obesity and Maternal Death in Virginia, 1999-2002 Published:  March, 2009

Pregnancy-Associated Maternal Death in Virginia, 1999-2001
   Full Report Published: October, 2007
   Executive Summary and Recommendation Published: October, 2007
   Report Preview. Published April, 2006

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