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Introduction: Women die due to complications during and following pregnancy and childbirth. Most of these complications develop during pregnancy and many are preventable or treatable. Maternal mortality in developing countries acts as one of the health indicators and reflects the efficiency of the nation health system. Aim: To analyse the cause of maternal death in tertiary care setting over a period of five years. Materials and Methods: The present study was a retrospective, observational study, conducted over a period of five years, from April 2015 to March 2020 in the Department of Obstetrics and Gynaecology, Jhalawar Medical College, Jhalawar, Rajasthan, India. The case records and death review forms of all maternal mortality were collected from hospital records and studies. Data regarding age, parity, locality, booking status, mode of delivery, cause of death, neonatal outcome, etc were collected in pretested proforma and then statistically analysed. Results: There were 115 maternal deaths from April 2015 to March 2020. The average Maternal Mortality Ratio (MMR) over a period of five years was 243 per one lac live births in institute setting. Majority of maternal mortality were from toxaemia (25.2%), anaemia (20.8%), haemorrhage (20.0%) and sepsis (15.7%). Conclusion: High maternal mortality is an important issue regarding maternal care. Toxaemia (hypertensive disorder of pregnancy), haemorrhage, sepsis and anaemia are still the common cause of maternal death. It can be prevented/reduced by improving healthcare facility in rural area by ensuring round the clock availability of gynaecologist, anaesthetist, blood product, intensive care facility and timely referral of high risk pregnancies. Family welfare services should be improved to reduce unwanted pregnancy. [ABSTRACT FROM AUTHOR]