BACKGROUND: Although the common direct obstetric causes of maternal mortality are known from the literature, the contribution of each cause and the change in trend over decades is unknown in Ethiopia. The objective of this review was to assess the trend of proportion of maternal mortality due to the common direct causes.

METHODS: This systematic review was done on eighteen health facility based maternal mortality studies conducted between 1980 and 2012 in Ethiopia. Emphasis was given to the proportion of maternal mortality due to direct causes and their case fatality rates.

RESULTS: The summary of the findings has shown that the top four causes of maternal mortality in the year 1980-1999 were abortion related complications (31%), obstructed labor/uterine rupture (29%), sepsis/infection (21%) and hemorrhage (12%). In the last decade, however, the top four causes of maternal mortality were obstructed labor/uterine rupture (36%), hemorrhage (22%), hypertensive disorders of pregnancy (19%) and sepsis/infection (13%).

CONCLUSION: Abortion and infection related maternal deaths have declined significantly in the last decade. Obstructed labor continues to be the major cause of maternal deaths; maternal deaths due to hypertensive disorders and hemorrhage showed an increasing trend. The findings in this review were somehow comparable with the WHO analysis for Africa in the same period with the exception of obstructed labor.