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Data were collected prospectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Identification criteria, main causes and incidence of <jats:styled-content style=\"fixed-case\">SMM<\/jats:styled-content>; case\u2010fatality rates, morbidity\u2013mortality index and effective intervention's use rate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 552 women with life\u2010threatening conditions were identified: 518 with <jats:styled-content style=\"fixed-case\">SMM<\/jats:styled-content>, 34 with <jats:styled-content style=\"fixed-case\">MM<\/jats:styled-content>. Identification criteria for <jats:styled-content style=\"fixed-case\">SMM<\/jats:styled-content> were case\u2010management (48.9%), organ dysfunction (15.2%) and mixed criteria (35.9%). Incidence of <jats:styled-content style=\"fixed-case\">SMM<\/jats:styled-content> was 0.8% (95% confidence interval [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>] 0.73\u20130.87%) and hospital maternal death ratio was 52.3 per 100\u00a0000 live births (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 35.5\u201369.1). Main causes of <jats:styled-content style=\"fixed-case\">MM<\/jats:styled-content> were abortion complications and puerperal sepsis; main causes of <jats:styled-content style=\"fixed-case\">SMM<\/jats:styled-content> were postpartum haemorrhage and hypertension. Overall case\u2010fatality rate was 6.2% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 4.4\u20138.6): the highest due to sepsis (14.8%) and abortion complications (13.3%). Morbidity\u2010mortality index was 15:1 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 7.5\u201330.8). Use rate of known effective interventions to prevent or treat main causes of <jats:styled-content style=\"fixed-case\">MM<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">SMM<\/jats:styled-content> was 52.3% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 46.9\u201357.7).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study describes the importance of life\u2010threatening obstetric complications that took place in public hospitals with comprehensive obstetric care and the low utilisation of known effective interventions that may decrease rates of <jats:styled-content style=\"fixed-case\">SMM<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">MM<\/jats:styled-content>. 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