Original Study/Estudo Original 256 Acta Obstet Ginecol Port 2018;12(4):256-260 *Professora Associada, Faculdade de Medicina do Huambo da Universidade José Eduardo dos Santos. Especialista em Ginecologia e Obstetrícia, Mestre em Educação Médica. **Assistente de Investigação, Faculdade de Medicina do Huambo da Universidade José Eduardo dos Santos. Mestre em Psicologia Clínica, Departamento de Investigação Científica e Publicações. ***Professor Associado com Agregação, Faculdade de Medicina da Universidade de Lisboa. Assistente Sénior, Departamento de Obstetrícia, Ginecologia e Medicina de Reprodução, Centro Hospitalar Universitário Lisboa Norte-Hospital de Santa Maria. dental or incidental causes 1,2 . ” Maternal mortality is a robust and sensitive indica- tor of the differences in level of healthcare among so- cial groups, regions and countries. It reflects access and quality of care during pregnancy, and is closely related to other less robust indicators such as perinatal mor- tality, maternal and neonatal morbidity, and permanent sequelae for the mother and child 3 . An estimated 576.300 maternal deaths occurred worldwide in 1990, while in 2010 this decreased to 287.000 2 . High-resource countries report maternal mortality rates (MMRs) of 5-10 per 100.000 births, while some low-resource countries in Sub-Saharan Africa and Asia report MMRs of 500-800. Angola has an estimated rate of 593, and although this represents a large improvement from the 1309 estimated in 1980, 1.156 in 1990, and 1.105 in 2000, it remains one of the highest in the world. Abstract Aim: Maternal mortality is particularly frequent in Sub-Saharan Africa, and Angola is believed to have one of the highest ra- tes in the world. The aim of this study was to identify the main causes of maternal deaths in the four reference hospitals of the Huambo Province, from 2011-2013. Methods: In this observational study, we analyzed maternal deaths recorded between 2011 and 2013, reviewing the clinical records and corresponding record books of the four main hospitals of the Huambo Province. Results: We identified a total of 164 maternal deaths. Almost 50% of women were between 15 and 24 years, 29.2% only had primary education, 48.1% resided in rural areas, and 39% were transferred from other health facilities. Data on previous pre- gnancies and deliveries, as well as on prenatal care were frequently missing. Most maternal deaths were from direct causes (77.4%), with hypertensive diseases accounting for 25%, sepsis for 23.1%, haemorrhage for 17.6%, and uterine rupture for 9.7%. Of the indirect causes, the most frequent were hepatitis, malaria, tuberculosis and HIV/AIDS. Conclusions: Hypertension, sepsis and hemorrhage are leading causes of maternal deaths in the Huambo region. Poor qua- lity of hospital and prenatal care records is frequent. These findings can help to guide strategies to reduce maternal mortality in the region. Keywords: Maternal mortality; Sub-Saharan Africa; Hypertensive diseases of pregnancy; Obstetric hemorrhage; Sepsis. Causes of maternal mortality in four reference hospitals in Huambo Province from 2011 to 2013 Causas de mortalidade materna em quatro hospitais de referência na Província do Huambo no período de 2011 a 2013 Cezaltina Nanduva Kahuli*, Victor Nhime Nungulo**, Diogo Ayres-de-Campos*** Hospital Regional do Huambo; Hospital Municipal do Bailundo, Hospital Municipal da Caala e Hospital Municipal do Cambiote. INTRODUÇÃO I n the 10th review of International Classification of diseases (ICD-10), the World Health Organization (WHO) defines maternal death as “the death of a wo- man while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by pregnancy or its management, but not from acci-