Abstract: To identify causes of maternal mortality in Isfahan province, summarize case review findings and suggesting strategies for improving maternal outcomes. A descriptive, cross-sectional survey of maternal deaths occurring in Isfahan province of Iran from 2001-2006 was enrolled. All available documents about women who died during pregnancy or within 42 days after termination of pregnancy according to hospital medical records and health system reports were reviewed for demographic data, medical and obstetrical history, failures in management and causes of deaths. Sixty six maternal deaths were recorded during study period. The mean age of them was 29.1±4.7. About 60% of them were illiterate or in elementary school grade. Eighteen woman (27.3%) died in prenatal period, 8 (12.1%) died during delivery and 40 (60.6%) died after delivery. (33.7%) of their pregnancies were unplanned. Prenatal care of 40 mothers (60.6%) was not satisfactory. The major causative factors were hemorrhage 23 (34.8%), hypertensive disorders 12 (18.2%), cardiovascular disease 11 (16.6%). The failure in managing obstetrical emergences was seen in %55 of maternal deaths. Obstetrical hemorrhage and hypertensive disorders are still major causes of maternal death. A high percentage of maternal deaths are preventable and improving the quality of care in all levels of maternal care and sensitizing health care professional about obstetrical complications is recommended in Isfahan.