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Objective To determine the incidence of, and the demographic and obstetric factors associated with, severe maternal outcome (SMO) among women presenting at healthcare facilities in Pakistan. Methods A cross-sectional study was conducted in 16 healthcare facilities across Pakistan that had been selected for the WHO Multicountry Survey on Maternal and Newborn health. The hospital records of women who delivered at a participating facility or were admitted with SMO (defined as maternal death or near miss) within 7 days of delivery/abortion were reviewed for a period of 2–3 months in 2011. The incidence of SMO, its associated demographic and obstetric characteristics, and the influence of various maternal health interventions were assessed. Results Among 13 175 included women, 132 (1.0%) had an SMO (94 [0.7%] near miss and 38 [0.3%] died). The maternal mortality ratio was 299 deaths per 100 000 live births. Major causes of SMO included postpartum hemorrhage (64 [48.5%] women), hypertensive disorders (34 [25.8%]), and ruptured uterus (9 [6.8]). Illiteracy, anemia, and several obstetric complications (e.g. eclampsia) were significant contributors. Conclusion Improving education, nutrition, and uniform implementation of obstetric care protocols are needed for better maternal and neonatal health in Pakistan. [ABSTRACT FROM AUTHOR]