Determinants of Maternal Mortality in a Tertiary Referral Hospital in North-Central Nigeria: A 10-Year Retrospective Review (2016–2025)

Background Maternal mortality remains a major public health challenge in Nigeria, particularly in tertiary referral facilities managing severe obstetric complications. Facility-level evidence is critical for guiding targeted interventions. Methods A retrospective review of maternal deaths occurring between January 2016 and December 2025 was conducted at Plateau State Specialist Hospital, Jos. Data were extracted from maternity registers, case notes, theatre records, blood bank logs, ICU registers, and Maternal Death Surveillance and Response (MDSR) reports. Descriptive and multivariable analyses were performed. Results Ninety-four maternal deaths occurred among 21,478 live births, yielding a facility-based maternal mortality ratio of 438 per 100,000 live births. Direct obstetric causes accounted for 86.2% of deaths, with postpartum hemorrhage (28.7%) and hypertensive disorders of pregnancy (18.1%) being the leading causes. Delay in the decision to seek care was identified in over 90% of cases. Referral status, hemorrhage, blood transfusion requirement, and ICU admission were independently associated with facility-level delays. Conclusion Maternal mortality in this tertiary facility remains high but largely preventable. Strengthening referral systems, blood transfusion services, emergency obstetric response capacity, and use of MDSR findings is essential to reduce preventable deaths.