Maternal Mortality Review Committee Decisions Form (New! updated form)

There are six key decisions that maternal mortality review committees make for each death reviewed:

  1. Was the death pregnancy-related?
  2. What was the cause of death?
  3. Was the death preventable?
  4. What were the critical contributing factors to the death?
  5. What are the recommendations and actions that address those contributing factors?
  6. What is the anticipated impact of those actions if implemented?

If available, the following additional information should be captured and included in case presentations to prompt reflection on these influences:

  • Did obesity contribute to the death?
  • Did discrimination contribute to the death?
  • Did mental health conditions contribute to the death?
  • Did substance use disorder contribute to the death?
  • Was the death a suicide?
  • Was the death a homicide?
  • If this death was a homicide, suicide, or accidental death, list the means of fatal injury.
  • If this death was a homicide, what was the relationship of the perpetrator to the decedent?

The Maternal Mortality Review Information Application (MMRIA) is a comprehensive database that provides for standardized documentation of committee decisions. The MMRIA Committee Decisions Form may be printed and distributed with case review materials to facilitate committee discussion. (Note: updated v.22 form now replaces v.21 form)

Year of publication and/or last update:
Contact name:
Julie Zaharatos
Resource Type Tags:
Process Maps, Graphics and Decision Aids
Review Stage Tags:
Case Abstraction
Case Review
Case Selection
Role Tags:
Case Abstractor
Committee Chair
Committee Coordinator
Epidemiologists and Data Analysts