- Severe Maternal Morbidity Reporting Form – Short Form
- Severe Maternal Morbidity Reporting Form – Long Form
Process for Reviewing Severe Maternal Morbidity Event
- Pregnant, peripartal or postpartum women receiving 4 or more units of blood products
- Pregnant, peripartal or postpartum women who are admitted to an ICU as defined by the center.
- Other pregnant, peripartal or postpartum women who have an unexpected and severe medical event – at the discretion of the facility
Multidisciplinary standing committee at facility representing:
- Obstetrical providers (obstetricians, family physicians and/or advanced practice nurses)
- Anesthesia providers
- Obstetric care nurses
- Facility quality improvement team
- Facility administration
- Patient advocate (should be considered)
- If small center, consider partnering with regional perinatal center or outsourcing the review.
- As close as possible to the time of the event
- The more severe the event, the closer the timing to review
- If large birthing facility with a number of events, consider scheduling regular meeting to do reviews.
- Reviews should be sanction by the facility and protected from discovery. Confidentiality statements should be gathered from each committee member.
- Gather all past and current patient medical records and facility records regarding this patient and event.
- Engage a trained reviewer/abstractor to complete Part A, the Abstraction Form, including a pertinent synopsis of the event and objective information found in the records.
- Primary review is then presented to the review committee.
- Reviews follow a standard format, such as Part B – The assessment form
- Review concludes with recommendations.
This form was originally developed by the California Pregnancy-Associated Mortality Review (CA-PAMR) using Title V MCH funding and is adapted with permission from the California Department of Public Health, Maternal, Child and Adolescent health Division. Sacramento, CA.