Twenty-nine maternal deaths were identified among 8656 pregnant women residing in Assiut city and three surrounding villages (Upper Egypt). This gives a maternal mortality ratio of 368 per 100 000 live births. Of these maternal deaths 83% were due to direct obstetric causes (hemorrhage, eclampsia, ruptured uterus and sepsis). Logistic regression analysis showed that residence (in villages versus Assiut city), parity (nullipara and grandmultipara) and illiteracy were significantly associated with increased risk of maternal death