Arkansas Maternal Mortality Review Committee
The Arkansas Maternal Mortality Review Committee (AMMRC) began with the passage of Act 829 of 92nd General Assembly Regular Session, 2019. The AMMRC was developed with guidance from the Centers for Disease Control and Prevention (CDC) Building US Capacity to Review and Prevent Maternal Deaths and is modeled after well-established review committees in the United States.
To improve maternal health outcomes, you must begin with understanding the factors that contribute to maternal mortality. The Arkansas Department of Health (ADH) established inter-and intra-agency agreements to identify maternal deaths and to access records to facilitate committee review. Through data collection and analysis of clinical factors, preventability, and social determinants, the AMMRC seeks to identify factors that lead to poor maternal health outcomes and to make recommendations that will decrease maternal mortality and morbidity.
The AMMRC is a multidisciplinary committee whose members represent the Arkansas Department of Health's five public health regions and various specialties, facilities, and systems that interact with and impact maternal health.
Twenty-one members have been appointed by the Arkansas Secretary of Health. Membership consists of specialists in obstetrics and gynecology, maternal-fetal medicine, anesthesiology, nursing, psychiatry, mental/behavioral health, nurse midwifery, public health, hospital association, patient advocacy, and more. Recruitment of new AMMRC members may occur annually as needed unless a specific type of expertise is required during the year for a case review (Example: domestic violence).
All AMMRC members serve in a volunteer capacity and do not receive compensation for participation in the review process. ADH Family Health Branch formed an internal workgroup to provide administrative support for the committee.
What is maternal mortality?
In understanding maternal mortality or deaths, several terms exist depending on what and who the term is being used for (i.e., surveillance and reporting, public education, grant applications, etc.). Below are a few common terms and definitions:
- Maternal death: The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective 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 or incidental causes.
- Maternal mortality rate: The number of maternal deaths per 100,000 live births.
- Pregnancy-related mortality ratio: The number of pregnancy-related deaths per 100,000 live births.
The scope of cases for Arkansas review is all pregnancy-associated deaths or any deaths of women during pregnancy or up to 365 days after pregnancy ends. In July 2020, committee members set forth exclusion criteria for abstraction (i.e., motor vehicle accidents and out-of-state residents). Deaths are identified from a review of death certificates, based on the cause of death, a pregnancy check box selection, or linkage of vital records by searching death certificates of women of reproductive age and matching them to birth or fetal death certificates in the year of or the year prior to the woman’s death.
The purpose of the AMMRC is to identify and characterize maternal deaths with the goal of identifying prevention opportunities.
To protect and improve the health and well-being of all Arkansans by eliminating preventable maternal deaths in Arkansas.
Optimize health for all Arkansans to achieve maximum personal, economic, and social impact.
The goals of the AMMRC are to:
- Perform thorough record abstraction to obtain details of events and issues leading up to a mother’s death.
- Perform a multidisciplinary review of cases to gain a holistic understanding of the issues.
- Determine the annual number of maternal deaths related to pregnancy (pregnancy-related mortality).
- Identify trends and risk factors among pregnancy-related death in Arkansas.
- Recommend improvements to care at the individual, provider, and system levels with the potential for reducing or preventing future events.
- Prioritize findings and recommendations to guide the development of effective preventive measures.
- Recommend actionable strategies for prevention and intervention.
- Disseminate the findings and recommendations to a broad array of individuals and organizations.
- Promote the translation of findings and recommendations into quality improvement actions at all levels.
In 2018, the total number of live births in Arkansas was 36,748. There were 40 reported maternal deaths. This included all deaths of women during pregnancy and within one year of the end of pregnancy from any cause.
Based on the exclusion criteria set forth by the committee members, 10 cases were excluded from the scope of review for Arkansas, and the remaining 30 cases were selected to be abstracted and reviewed. The 2018 cases determined to be outside the scope for review by the AMMRC included:
- Not pregnant within one year of death: 4
- Non-Arkansas resident: 3
- Motor vehicle accident: 2
- Accident/Trauma: 1
The AMMRC meets quarterly to review select cases and make recommendations about each case based on the case narrative and abstracted data. These are closed meetings. Members of the public or press will not be allowed at AMMRC meetings. If members of the public or press show up uninvited at a meeting, they will be notified that the AMMRC meetings are not open to the public and will be asked to leave. Members of the public or press will be offered the opportunity to engage with ADH staff about the work at a separate time outside of the AMMRC meetings. The committee examines the cause of death and contributing factors. This multidisciplinary group assembled for the first official meeting in January 2020.
For questions, please contact: ADH-AR.Maternal.Mortality.Review@arkansas.gov