Maternal mortality is devastating for families and communities worldwide. In Pennsylvania specifically, a large disparity exists between white and African American women for maternal mortality. Unfortunately, mortality is just the tip of the iceberg: for every woman who dies, there are more women who just barely survive. Because of this, Governor Wolf has made maternal and child health a priority for the state of Pennsylvania.
What is Maternal Mortality?
Maternal mortality is a death of a woman during pregnancy, or up to one year following the end of the pregnancy, regardless of the outcome of the pregnancy. Maternal mortality applies in cases of livebirth, stillbirth, abortion and miscarriage. When describing maternal mortality, deaths are divided into the following categories:
Pregnancy Associated Deaths: the death of a woman during pregnancy, or up to one year following the end of the pregnancy, regardless of the outcome of the pregnancy.
Pregnancy-related death: the death of a woman during pregnancy or within one year of the end of a pregnancy - regardless of the outcome, duration or site of the pregnancy -
due to 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: the death of a woman during pregnancy or within one year of pregnancy
from a cause that is not related to pregnancy. These are deaths from accidental or incidental causes, such as a death due to a natural disaster.
CDC's Vital Signs Report most pregnancy related deaths occur after pregnancy. Among these deaths, 31% occurred while pregnant, 36% occurred at delivery or in the week after, and 33% occurred one week to one year after pregnancy. Approximately three in five pregnancy related deaths were preventable. While we have some data about maternal mortality there is a lot that we do not know. To better understand maternal mortality and how to prevent these deaths, Pennsylvania established a maternal mortality review committee (MMRC) to review all pregnancy associated deaths in the commonwealth.
What is a Maternal Mortality Review Committee?
A maternal mortality review committee (MMRC) is a group of professionals and partners who serve pregnant and postpartum women, and who collectively review these deaths and examine factors that led to the death. The goal of a MMRC is to determine if the death is related to the pregnancy and if it could have been prevented. The committee then provides recommendations that could prevent future deaths and protect the health and well-being of women during and after pregnancy.
PA Maternal Mortality Review Committee
In 2018, the PA MMRC was established by
Act 24 to confidentially conduct a multidisciplinary review of maternal mortality in Pennsylvania. Under the act, the Department of Health has authority to appoint members to the committee and maintain a minimum committee representation. It also allows the committee to consult with relevant experts or stakeholders,
The PA MMRC reviews de-identified summaries of
all pregnancy associated deaths in the commonwealth, regardless of cause of death and including drug-related deaths, homicides, and suicides. The committee determines if the death was related to the pregnancy, identifies contributing factors, determines if the death could have been prevented, and makes recommendations to prevent future deaths. A death is considered
preventable if the committee determines that there was at least some chance of the death being avoided by one or more reasonable changes to patient, family, provider, facility, system and/or community factors.
The PA MMRC works closely with the Philadelphia MMRC, which reviews deaths of Philadelphia mothers. The Philadelphia MMRC is housed within the Philadelphia Medical Examiner's Office. The Philadelphia MMRC began in 2010 and is made up of representatives from every labor and delivery hospital in Philadelphia, as well as diverse disciplines.
PA MMRC Mission
The Pennsylvania Maternal Mortality Review Committee's goal is to systematically review all maternal deaths, identify root causes of these deaths and develop strategies to reduce preventable morbidity, mortality and racial disparities related to pregnancy in Pennsylvania.
PA MMRC Members
- Amanda Flicker, MD, FACOG, Ob/Gyn, Lehigh Valley Health Network
- Amy Whitsel, MD, Ob/Gyn, Maternal Fetal Medicine, Allegheny Health Network
- Antoine Douaihy, MD, Professor of Psychiatry and Medicine, University of Pittsburgh Medical Center
- Betty Braxter, PhD, CNM, TTS, RN, Assistant Professor, University of Pittsburgh
- Carolyn Byrnes, MPH, CPH, Physician General Staff Assistant, Pennsylvania Department of Health
- Christina VandePol, MD, Coroner, Chester County
- Dannai Wilson, MS, Maternal Child Health, Allegheny County Health Department
- Dara Mendez, PhD, MPH, Assistant Professor, University of Pittsburgh
- David F. Silver, MD, MBA, FACOG, Gynecologic Psychiatrist, Women's Behavioral Health, UPMC Pinnacle
- Denise Johnson, MD, FACOG, FACHE, Acting Physician General, Pennsylvania Department of Health
- Jason Baxter, MD, MSCP, FACOG, Director of Obstetrics, Thomas Jefferson University
- Jessica Riley, MD, Department of Emergency Medicine, Wellspan York Hospital
- Joanne Craig, MS, Vice President for Programs, The Foundation for Delaware County
- Julia Greenawalt, PhD, RNC-OB, CHSE, Associate Professor, Indiana University of Pennsylvania
- Karen Pollack, MSW, Vice President of Programs, Maternity Care Coalition
- Kay-Ella Bleecher, RN, MSN, CRNP, CEN, EMS Coordinator, Education Specialist/Nurse Educator, Harrisburg Area Community College
- Margery Wasko, MD, Lead Consultant, Medical Director, Pennsylvania Department of Human Services, Office of Medical Assistance Programs
- Nancy Niemczyk, CNM, PhD, Assistant Professor, Nurse-Midwifery Program Director, University of Pittsburgh
- Nazanin E. Silver, MD, MPH, FACOG, Gynecologic Psychiatrist, Women's Behavioral Health, UPMC Pinnacle
- Patricia Ross, LPN, D-ABMDI, Coroner, Blair County
- Roy Hoffman, MD, MPH, Medical Director, Fatality Review Program, Philadelphia Department of Public Health
- Sarah Kawasaki, MD, Addictions Specialist, Director of Addictions Services, Penn State Hershey Medical Center
- Sindhu Srinivas, MD, MSCE, Maternal Fetal Medicine, University of Pennsylvania
- Sonya Borrero, MD, Associate Professor, University of Pittsburgh
- Stacy Beck, MD, Ob/Gyn, Assistant Professor, Maternal Fetal Medicine, University of Pittsburgh, Magee Women's Hospital
- Stefanie Porges, MD, Emergency Department, Hospital of the University of Pennsylvania
- Stephen Smith, MD, MBA, Maternal Fetal Medicine, Abington Hospital
- Tara Trego, Director, Bureau of Family Health, Pennsylvania Department of Health
- Valerie Arkoosh, MD, MPH, Chair, Montgomery County Board of Commissioners
PA Perinatal Quality Collaborative
Pennsylvania Perinatal Quality Collaborative (PQC) is a PA MMRC partner and primarily focuses reducing maternal mortality and improving the care of pregnant and postpartum women and newborns affected by opioids. The PA PQC works to improve the quality of care for mothers and babies across prenatal, labor/birth, newborn, and postpartum services. In its partnership with the PA MMRC, the PA PQC serves as a disseminator of the recommendations and strategies developed by the PA MMRC. The PA PQC is administered by the Jewish Healthcare Foundation and WHAMglobal.
Learn More about Maternal Mortality
National Statistics on pregnancy-related deaths
- More than half of the nearly 700 deaths from pregnancy-related complications each year in the US are preventable.
- Heart disease and stroke cause more than 33% of pregnancy-related deaths, with infections and severe bleeding also a major cause of severe infections.
- At delivery, the cause of most deaths are obstetric emergencies, such as severe bleeding and amniotic fluid embolism.
- Severe bleeding, high blood pressure and infection are the highest contributors to death one week after delivery.
- Between one week to one year after delivery, cardiomyopathy is the leading cause of pregnancy-related deaths.