Objective: To determine the pattern and associated obstetric risk factors of severe acute maternal morbidity and maternal death in tertiary care hospital so that guideline can be formed for health personnel in an attempt to reduce the incidence of SAMM & maternal death. Methods: A prospective descriptive study was conducted in gynecology & obstetric department civil hospital Karachi. All the women admitted in gynaecology & obstetric department with case history fitting the definition of severe acute maternal morbidity and all maternal death were included in the study. Both groups were comparatively analyzed for demographic characteristic and obstetric risk factors in each case. Results: A total of 420 women 393(93.57%) were cases of severe acute maternal morbidity and 27(6.42%) were maternal death. Mean age was 27.24 ± 52 SAMM & 28.15 in maternal death group (p = 0.38). Most women were in parity group 1-4, 56% & 70.4% respectively in SAMM and maternal death cases. Referred cases were 24.9% & 56.6% (p- 0.002) in cases of SAMM & maternal death respectively. In SAMM & maternal death groups haemorrhage was present in 46.85% & 81.5%, (p=0.001), Hypertension was present in 9.9% & 7.4%, infection 1.5% & 22.2%, anemia in 24.17% & 48.1% cases of SAMM & maternal death respectively. Dystocia (40.2%) was present only in SAMM group. There were 5 and 1 case of perforated viscera in SAMM & maternal death group respectively. Conclusion: Cases of SAMM in addition to audit of maternal death give more information regarding quality of maternity care system available in our country.