BACKGROUND Maternal near miss is an event where pregnant women come close to death but escape narrowly from missing, i.e. "near miss". Review of near miss cases has the potential to highlight the deficiency as well as the positive elements in the provision of obstetrics services in any health system. This study has been done to evaluate the frequency and to find out the determinants of maternal morbidity and mortality. METHODS Near miss cases were prospectively identified among all pregnant and recently delivered women with pregnancy related complications, who were admitted to the hospital and analysed in terms of MNM incidence ratio and maternal near miss to mortality ratio. Higher ratio indicates better care MNM:1MD. RESULTS Out of 16560 deliveries, 14272 were live births, 210 were suspected of near miss, 180 were confirmed hypertensive disorders (N=93,51.6%) haemorrhage (N=46,25.5%), sepsis (N=25 13.3%) and dystocia (N=12, 6.6%). 80.5% belonged to BPL category. 16.6% had 3 or more ANC while 83.3 had less than 3 ANC. After delivery 42.7% were in shock, 18.8% in PPH, 12.7% in sepsis/MODS, 3.3% in pulmonary oedema, 3.8% in HELLP/DIC. 92.7% cases had a duration of hospital stay of >7 days as compared to 7.3% with <7 days. The total maternal near miss ratio was 12.6 per 1000 live births. CONCLUSIONS The delay in referrals is a major cause of morbidity and mortality. Establishment of a tertiary care center in each district is essential. Delayed diagnosis, inappropriate transfer, and inadequate utilization of resources might have been the cause for maternal morbidities and mortalities in our study.