This chapter focuses on pathophysiology of maternal deaths. Each maternal death is a tragedy, but bigger tragedy is failing to learn lessons from the avoidable maternal deaths. Maternal deaths are deaths associated with pregnancy and childbirth. These deaths are among the most significant public health problems in developing and poor nations, and are considered to be avoidable deaths. Most common causes of maternal mortality include postpartum hemorrhage, eclampsia, obstructed labor, unsafe abortions and sepsis. Pathological autopsy is essential and useful tool in reducing the maternal mortality rate. For this reason, a detailed, meticulous postmortem examination should be done after taking due consent from the relatives to find the cause of death. Before starting the autopsy, clinical information and laboratory data should be obtained. Detailed discussion should be made with the concerned doctor involved in the pregnant female’s care. Classification of maternal deaths, epidemiology, direct and indirect causes of maternal deaths, and late and fortuitous deaths are also provided in this chapter.