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Background: The problem of maternal deaths cannot be solved without having accurate information about the number and causes of these deaths. The aim of this study was to determine the exact cause of maternal deaths during childbirth in Isfahan, Iran in 2006_2011. This was made by determining the direct and indirect causes of maternal deaths, autopsy reports and prenatal care. Methods: In a descriptive, analytical and cross sectional study the list of  women who died from the beginning of the pregnancy till 42 days after delivery in 2006_2011 was obtained from the department of health. The files of these mothers were studied along with the autopsy reports and health department documents. Findings: in 67 cases that were studied the most maternal mortality occurred in 2010 with 14 deaths. The most common cause of death according to both clinical findings and autopsy reports was bleeding (Atony). There was a significant relationship between autopsy reports and clinical findings (P<0.001).72% of maternal deaths were due to direct causes; bleeding (36.2%), Hypertensive complication (26%), Thromboembolism (17.3%) and 28% due to indirect causes with cardiac being the most common (47.3%). Incomplete recording of data, lack of a rapid response team protocol in emergent situations and insufficiency in the services given were the most problem in the prenatal care. Conclusion: in this study considering all the aspects due to maternal deaths the most common cause was bleeding, hypertensive complication and cardiac. Reducing maternal deaths could be achieved by giving education to people, increasing the quality and the coverage of prenatal care and providing more equipment for hospitals. Key word: Autopsy, Maternal Mortality, pregnancy

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