Maternal Mortality Review Team outlines methods, data limits and recommendations to the General Assembly

Dr. Melanie Rouse, presenting the Maternal Mortality Review Team's (MMRT) procedures and findings, told the Life Experiences Subcommittee that the team conducts multidisciplinary, retrospective case reviews intended to identify contributors to pregnancy‑associated deaths and develop prevention-focused recommendations. The MMRT's work emphasizes record collection across medical, social‑service and law‑enforcement sources and seeks consensus among team members rather than individual blame.

Rouse described the team's case‑identification methods: linking vital records and death certificates (including ICD‑10 obstetric codes and a pregnancy checkbox), searching the Virginia violent death registry, and supplementing with hospital records, autopsies, police reports, and media reports when necessary. She said the team verifies cases before review because errors in death certificates are common; the team is working with the Office of Vital Records to reduce those errors.

On findings, Rouse reported that for cases with final data from 2018–2023, 18.2 percent had a known history of intimate‑partner violence, about 45.8 percent had no known history, and just under 20 percent were unknown. She said the majority of cases resulted in live birth; 27.8 percent of decedents were pregnant at the time of death, 10.7 percent experienced a fetal death prior to the decedent's death, and 3.7 percent had a termination during the index pregnancy. Rouse cautioned that small annual numbers mean year‑to‑year trends should be interpreted carefully.

Rouse flagged data limitations: identification and verification typically take 12–18 months after death because finalized death‑certificate data are delayed, and federal changes to medical‑release procedures have complicated record access in some cases. To manage high caseload years (for example, 67 cases in 2022), the MMRT conducts full reviews for pregnancy‑related deaths and samples other pregnancy‑associated cases for abbreviated review, with the option to expand any abbreviated case to a full review if needed.

The MMRT's policy recommendations (drawn from its 2025 report) include: requiring all hospitals to participate in the Virginia Perinatal Quality Collaborative's levels‑of‑maternal‑care survey and making that information public to help families and clinicians choose appropriate care; requiring dispensers in opioid‑treatment programs to report to the MMRT through the prescription‑monitoring program and enabling providers to track unfilled prescriptions for medication‑assisted treatment; funding at least one evidence‑based residential family program per health district developed with community stakeholders; and strengthening mental‑health and substance‑use treatment access and workforce capacity.

Members pressed on implementation. Commissioners asked whether community organizations are appointed to the MMRT; Rouse said many team members are appointed through the governor's office and that she would check statutory appointment details for specific organizations. Members also asked whether certain violent deaths (including homicide and trafficking‑related deaths) are included; Rouse said homicides are included and the team documents intimate‑partner violence or trafficking as contributors when case review indicates they were factors.

Rouse emphasized that many MMRT recommendations are already captured in published cohort reports and an online dashboard that lists individual recommendations; those reports and the dashboard will be available through OCME and related websites this fall. She told members that reducing delays in death‑certificate finalization would help the MMRT identify cases sooner.

The subcommittee requested additional follow‑up: clarifications on appointed membership, data‑sharing barriers caused by federal release forms, and opportunities to shorten identification lags through administrative or statutory fixes. The MMRT presentation concluded with an offer to provide the annual and topic‑specific reports and to supply staff with contact information for follow‑up.