Objectives: The objectives were to determine the clinical and demographic profile of maternal deaths, determine the most common primary causes of maternal deaths at district hospital level, compare the causes of deaths at district hospital, provincial and national level, and to investigate the quality of care that was provided to maternal deaths patients and to make recommendations.

Design: The design was a cross-sectional retrospective chart review.

Setting and subjects: Subjects were all reported maternal deaths between January 2006 and December 2010 at Northdale Hospital, KwaZulu-Natal.

Outcome measures: Outcome measures were the common characteristics and causes of maternal deaths, avoidable maternal deaths and quality of care.

Results: The mean age of the 61 maternal deaths was 28 years. Thirty-three patients attended antenatal clinics. Of these, 57.6% booked at ≤ 20^th week. Of the 28 (45.9%) who died in the postpartum period, seven delivered at home and three died of anaesthetic complications. Thirty-nine patients (63.9%) tested positive for human immunodeficiency virus. Only 10 were on highly active antiretroviral therapy. The five leading causes of deaths were non-pregnancy-related sepsis, miscarriage, acute collapse, pregnancy-related sepsis and anaesthetic complications. Thirty patients (49.3%) received substandard care.

Conclusion: The profile of maternal deaths at this district hospital differs from the national profile published in 2005–2007 Saving Mothers Report. While there was an increase in maternal deaths at national level, maternal death numbers decreased at this district hospital. Non-pregnancy-related sepsis remained the leading cause of deaths at national and facility level, but the other four major causes at the hospital level differed from those at the national level.