Objective: To analyze causes of maternal deaths during 1978 - 1997 in the Czech Republic. Design: Retrospective epidemiological study. Setting: Department of Obstetrics and Gynecology, I st Medical School, Charles University, Praha 2, Institute for the Care of Mother and Child, Praha 4.Methods: The database of 521 maternal deaths which occurred during 1978 - 1997 was used to analyze causes of deaths with regard to demographic characteristics, time development since the occurrence of complications leading to death, age and parity, places of death including the type of facility, regional distribution, and actual historical situation of the Czech Republic during the observed period. The effect of interventions and quality of care were also taken into account. We provide the trend analysis of specific (direct) and non-specific (undirect) maternal mortality in 5-year periods. Results: Maternal mortality decreased from 29 deaths to 6 deaths per 100,000 live born newborns during the study period. Due to prevention of thrombembolic complications in 1993 by introduc- tion of obligatory micro-heparinization and prophylaxis of postoperative puerperal infections the maternal mortality decreased further by more than half. Hemorrhagic complications, usually with disorders of coagulation, become the leading cause of death; we are also observing increased incidence of HELLP syndrome. While evaluating quality of care we list the major mistakes and omissions in prevention, diagnosis and therapy; we noticed that in 32% of maternal deaths the care was not adequate according to possibilities and circumstances in a particular time period. Conclusions: Due to systemic surveillance of maternal deaths and introduction of preventive measures the Czech Republic belongs among the most developed countries in this area. We fur- ther intend to publish results of analysis of maternal mortality in particular nosologic groups according to cause of death.

        Key words: maternal mortality, causes of deaths, prevention, quality of care