Background: Maternal mortality remains a public health concern in low income countries particularly in sub-Saharan Africa where majority (62%) of maternal deaths occurs. In Tanzania maternal mortality ratio is as high as 432 deaths per 100,000 live births.

Objectives: This study aimed to describe pattern of maternal mortality ratio and its associated causes at Shinyanga regional referral hospital. We also assessed the availability of the comprehensive emergency obstetric care services in the study setting.

Methods: This was retrospective cross-sectional study which was conducted from April to May 2015 at Shinyanga Regional Referral Hospital. Information on demographic data, obstetric factors associated with maternal death and their causes as well as their management were extracted from the patient’s record file between 2010 and 2014 by using data extraction sheet. Data analysis was performed using SPSS version 18.0 for Windows (SPSS Inc, Chicago, IL, USA). Descriptive statistical analysis were summarized.

Results: Overall maternal mortality ratio declined from 635/100,000 live births in 2010 to 449/100,000 live births in 2014. The main causes of maternal death were postpartum haemorrhage (50%) and pre-eclampsia/eclampsia (20%). Majority (77%) of the delays were encountered at hospital and at home (56%). Numerous forms of management were provided to women who experienced maternal death including C-section (35.5%) for antepartum haemorrhage and hysterectomy (17%) for postpartum haemorrhage. For pre-eclampsia/eclampsia, only 12.5% had C-section. Of all of the maternal deaths, only 2.5% had assisted vaginal delivery and 14% had puerperal sepsis.

Conclusions: The observed maternal mortality ratio in this population is higher compared to the national average. Postpartum haemorrhage and preeclampsia/eclampsia remains to be the main direct causes of maternal deaths. Delay in decision making in seeking fortreatment and provision of treatment contributed to high maternal mortality observed in this study. This requires more effort to address the direct and indirect causes of maternal death.