OBJECTIVE: To identify frequency and risk factors in patients presenting with puerperal sepsis in tertiary care hospital. STUDY DESIGN: Retrospective study PLACE AND DURATION: Department of Obstetrics and Gynaecology (Unit-II) Liaquat University Hospital, Hyderabad, Sindh from June 2006 to May 2008. METHODS: The frequency and predisposing factors were analyzed in patients presenting with puerperal sepsis in tertiary level hospital. Medical record of patients who fulfilled criteria of puerperal sepsis was scrutinized and data was entered in a predesigned proforma. RESULTS: Over the study period 230 patients presented with puerperal sepsis representing 6.28% of 3656 admissions in gynecological unit II. So for risk factors were concerned all patient were anemic, 90.86% patients were unbooked and 64.34% patients arrived in university hospital after being from more than one station. 56.08 %patients had frequent vaginal examination(more than five), 54.78 % patients were delivered at home, 48.26% patients were with prolong rupture of membrane (>6hrs), and 46.52% cases with prolong labour. 16.95% patients were admitted with altered consciousness and mortality rate was 21.68%. CONCLUSION: The study concluded that puerperal sepsis was preventable in majority of cases. Maternal mortality due to puerperal sepsis was very high with 21.68%.