Introduction: WHO classifies Kenya as having a high maternal mortality. Regional data on maternal mortality trends is only available in selected
areas. This study reviewed health facility maternal mortality trends, causes and distribution in Central Region of Kenya, 2008-2012. Methods: We
reviewed health records from July 2008 to June 2012. A maternal death was defined according to ICD-10 criterion. The variables reviewed included
socio-demographic, obstetric characteristics, reasons for admission, causes of death and contributing factors. We estimated maternal mortality
ratio for each year and overall for the four year period using a standard equation and used frequencies means/median and proportions for other
descriptive variables. Results: A total 421 deaths occurred among 344,191 live births; 335(80%) deaths were audited. Maternal mortality ratios
were: 127/100,000 live births in 2008/09; 124/100,000 live births in 2009/2010; 129/100,000 live births in 2010/2011 and 111/100,000 live births
in 2011/2012. Direct causes contributed majority of deaths (77%, n=234) including hemorrhage, infection and pre-eclampsia/eclampsia. Mean age
was 30(±6) years; 147(71%) attended less than four antenatal visits and median gestation at birth was 38 weeks (IQR=9). One hundred ninety
(59%) died within 24 hours after admission. There were 111(46%) caesarian births, 95(39%) skilled vaginal, 31(13%) unskilled 5(2%) vacuum
deliveries and 1(<1%) destructive operation. Conclusion: The region recorded an unsteady declining trend. Direct causes contributed to the
majority deaths including hemorrhage, infection and pre-eclampsia/eclampsia. We recommend health education on individualized birth plan and
mentorship on emergency obstetric care. Further studies are necessary to clarify and expand the findings of this study.