About | Kansas Maternal Mortality Review Committee

Purpose

The purpose of our case review process is to determine the factors contributing to maternal mortality in Kansas, and to identify public health and clinical interventions to improve systems of care. Maternal mortality includes deaths occurring during pregnancy and up to one year after pregnancy.

Mission

Our mission is to increase awareness of the issues surrounding deaths during pregnancy, and to promote change among individuals, communities and healthcare systems to reduce the number of deaths.

Vision

Our vision is to eliminate preventable maternal deaths in Kansas.

Why our work matters

Maternal mortality cases – which are deaths from pregnancy-related causes – have been rising in the United States. Cases increased from seven deaths per 100,000 live births in 1987 to nearly 16 deaths per 100,000 in 2012 – more than doubling in just 25 years.*

Maternal health experts actively search for answers about why the U.S. ratio of pregnancy-related deaths is higher than other developed nations, why it is increasing, and why the disparity by race/ethnicity is widening.

State-level maternal mortality review committees – like the Kansas MMRC – are the gold standard for maternal mortality surveillance, and we have a critical role in answering these questions. Maternal mortality review committee members serve as key stakeholders in prevention efforts. To accurately count and characterize maternal deaths, individuals involved in the surveillance process should familiarize themselves with key definitions in maternal mortality and their use in maternal mortality.

*Source: Review to Action

Goals

Maternal Mortality Review Committee goals:

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 Kansas.
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 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.

Key Decisions

Maternal mortality review committees make six key decisions for each death reviewed:

Was the death pregnancy related?
What was the cause of death?
Was the death preventable?
What were the critical contributing factors to the death?
What are the recommendations and actions that address those contributing factors?
What is the anticipated impact of those actions if implemented?

NOTE: While all six questions are essential, the last four questions highlight the unique and critical role of the review committees: preventability, contributing factors, recommendations for improvement and measurement of impact.