Case Review

Case Identification Wheel

Information in this section includes excerpts from the comprehensive Abstractor Manual developed by the MMRIA project, a partnership with Review to Action. For more detailed information, please download the manual from the recommended resources below.

Case review is the stage where the value of a maternal mortality review committee (MMRC) is fully demonstrated.

The MMRC should follow a clear and structured process for case review. Using a standard process has many benefits:

  • Promotes consistent and complete case review
  • Provides direction and promotes efficiency of case review
  • Enhances committee focus and keeps case discussions on track
  • Corresponds to case abstraction tools to ensure seamless conversion from abstraction to review
  • Presents continual reminder of the priorities set for data elements and application
  • Records committee findings and recommended actions in a standard format
  • Fosters collection of consistent data that is comparable to other states and can be analyzed over time.

While the process selected may vary by state, the following reflects a guide to best practices for each case review meeting:

  1. Review the authority and protections under which the committee operates
  2. Review the mission, vision, purpose, and goals established by the committee and documented in the policies and procedures
  3. Review the definitions of pregnancy-associated, pregnancy-related, and pregnancy-associated but not related death
  4. Review the case identification process
  5. Present the case
  6. Facilitate the decision-making process
  7. Conclude by summarizing the cases reviewed

During the case presentation process, cases should be presented by a designated person such as the committee coordinator or chairperson. The committee may also choose to have the case abstractor report details about the cases or ask members to volunteer to present cases that pertain to their particular interest or expertise. Regardless of who is presenting the case, it is most beneficial to have a standard format and process to guide committee review and discussion.

During the case review process, the committee needs to make a number of key decisions:

  • Was the death pregnancy-related? Or, “If this woman had not been pregnant, would she have died?”
  • What was the underlying cause of death?
  • Was the death preventable? A death is considered preventable if the committee determines that there was at least some chance of the death being averted by one or more reasonable changes to patient, family, community, provider, facility, and/or systems factors.
  • What was the chance to alter the outcome?

For some cases, establishing a causal relationship between pregnancy and death will be straightforward. However, states who review deaths from injury (e.g. suicide, homicide, motor vehicle-related accidents) may find causality for such cases difficult to determine. Committees should rely on their members’ expertise to help assess case complexities and explore modifications or additional standards needed for the review of pregnancy-associated injury deaths. For deaths that are determined to be pregnancy-related, the committee should identify the critical factors associated with the death.

The committee's ability to craft recommendations closely relates to the case review process; in fact, recommendations are often discussed and identified at various parts of the committee’s discussion. Due to their importance and role in prevention of maternal deaths, they are discussed separately in the next section.

MMRIA Committee Facilitation Guide

Year of publication or last update: 

This guide is intended to share best practices that will help maternal mortality review committees (MMRCs) establish processes for case review. The guide is structured in the general order of steps a committee might take in conducting an actual review committee meeting. Your committee may choose to do things differently depending on your resources, committee makeup, and scope. Consider this document a tool to help you establish a strong foundation for committee facilitation from which to develop and build upon your own skills and experience.