ARKANSAS MATERNAL MORTALITY REVIEW COMMITTEE (AMMRC)
The Arkansas Maternal Mortality Review Committee (AMMRC) began with the passage of Act 829 of 92nd General Assembly Regular Session, 2019, and it first convened in 2020. The committee has approximately 21 members, meets quarterly, and reviews all pregnancy-associated cases. 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.
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 deteriorating maternal health outcomes and to make recommendations to limit maternal mortality and morbidity.
Membership
The AMMRC is a multidisciplinary committee whose members represent the state of Arkansas. The members consist of various specialties, facilities, and systems that interact with and impact maternal health.
The members are appointed by the Arkansas Secretary of Health and consist of specialists in obstetrics and gynecology, maternal-fetal medicine, anesthesiology, nursing, psychiatry, mental/behavior health, nurse midwifery, public health, hospital association, patient advocacy, and more. Recruitment of new AMMRC members occurs as needed.
All AMMRC members serve in a volunteer capacity and do not receive compensation for participation in the review process. ADH Family Health Branch maintains an internal workgroup to provide administrative support for the committee.
Case Review Process
The maternal mortality review process is a continuous cycle. Maternal Mortality Review Committees (MMRCs) gather extensive information about each individual maternal mortality selected for review to compile a narrative for that case.
Case Identification
Multiple strategies are employed to identify possible cases of pregnancy-associated death. The ADH Family Health Branch has established data sharing agreements with the Office of Health Information Technology (OHIT), ADH Health Statistics Branch, ADH Vital Statistics Section, and ADH Hospital Discharge Data System. In addition, an agreement has been established with CDC for data sharing and use of the Maternal Mortality Review Information Application (MMRIA). Pregnancy-associated deaths of Arkansas female residents of reproductive age are identified through one or more of the following criteria:
•Death certificate for a woman linked with a matching live birth certificate or a fetal death certificate;
•Death certificate for a woman with a cause of death related to pregnancy, childbirth, or postpartum period; or
•Death certificate for a woman with the pregnancy checkbox indicating that the death occurred during pregnancy or within one year of pregnancy.
Case Abstraction
Information for abstraction is gathered from maternal/neonatal death certificates, neonatal birth certificates, medical records, and autopsy reports. Additional data sources include hospital and emergency department records, obituaries, police reports, social media, media and news reports, certifier confirmation, and more. Records are then abstracted by a trained abstractor who prepares de-identified case narratives for Committee review.
Meeting Structure
The AMMRC meets quarterly to review and make decisions about each case based on the case narrative and abstracted data.
Organizations Represented by Members
- Arkansas Chapter Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN)
- National Maternal Morbidity and Mortality Taskforce
- Arkansas Hospital Association
- Arkansas State Crime Lab
- American College of Obstetricians & Gynecologists
- Society for Maternal-Fetal Medicine
- American Academy of Family Physicians, Arkansas Chapter
- Arkansas Department of Health
- Arkansas Foundation for Medical Care
- Arkansas Medical Society
- Arkansas Board of Nursing
- Arkansas Society of Anesthesiologists
- Arkansas Psychiatric Society
- University of Arkansas for Medical Sciences
- Arkansas Board of Health
- American College of Cardiology, Arkansas Chapter
- American College of Nurse-Midwives, Arkansas Affiliate