State Maternal Mortality Review (MMR) Program

Background

The Maryland State Maternal Mortality Review (MMR) Program was established in 2000 when Health-General Article, §13-1201 through §13-1207, Annotated Code of Maryland was enacted. The statute requires:
(1) Identification of maternal death cases;
(2) Review of medical records and other relevant data;
(3) Determination of preventability of death;
(4) Development of recommendations for the prevention of maternal deaths; and
(5) Dissemination of findings and recommendations to policymakers, health care providers, health care facilities and the public.

Maternal Mortality Review in Maryland

The Maryland Department of Health and Mental Hygiene (DHMH), Family Heath Administration, Center for Maternal and Child Health (CMCH) collaborates with the Maryland State Medical Society (Med Chi) to administer the Maternal Mortality Review Program. Since 2001, case reviews have been conducted to investigate all pregnancy-associated deaths in Maryland and identify opportunities for reduced maternal mortality. The CMCH collaborates with the Department’s Vital Statistics Administration to obtain vital records information for case reviews. Med Chi’s Maternal and Child Health Committee provides consultation regarding maternal mortality review activities, conducts case reviews, and develops recommendations for prevention of maternal deaths and assists the Department in the dissemination of findings.
Three terms, “maternal death,” “pregnancy-associated death,” and “pregnancy-related death” are utilized in the definition and identification of cases to review.

Maternal death: is defined by the World Health Organization’s (WHO) International Classification of Diseases Ninth Revision (ICD-9) and Tenth Revision (ICD-10) to be “the death of a woman while pregnant or within 42 days of conclusion of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by pregnancy or its management but not from accidental or incidental causes.
Pregnancy-associated death is the death of a woman while pregnant or within one year (365 days) of pregnancy conclusion, regardless of the cause of death.
Pregnancy-related death is defined as the death of a woman while pregnant or within one year of conclusion of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by her pregnancy or its management, but not from accidental or incidental causes.

All three definitions are considered in the case review process in Maryland.