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Background: Death of a woman during pregnancy and child birth is an extremely tragic event. It is a waste of a precious life that leaves great feeling of grief and pain for the family and hospital staff and has devastating influence on the community overall. Maternal Mortality Ratio (MMR) is a very sensitive index that reflects the quality of reproductive care provided to the pregnant women in that country. Maternal morbidity and mortality can be prevented by awareness of reproductive health in a community, availability, and utilization of organized antenatal care, skilled intrapartum management and careful postnatal follow up.Aim: Objective of the study was to analyze the pattern of maternal mortality over the period of five years in a tertiary level hospital in rural Maharashtra receiving high risk referred patients form periphery. Methods: A retrospective hospital based study of 81 maternal deaths over a period of 5 years from January 2012 to December 2016 is carried out. The information regarding demographic profile and reproductive parameters were collected and results were analyzed by using percentage and proportion. Results: Over the study period, there were 37242 live births, giving a MMR of 217.4/1,00,000 live births. Postpartum hemorrhage and sepsis were the leading direct causes while anemia was indirect leading cause. Most of the women died within 24 hours of admission. The 20 to 24 years age group and illiterate group was mainly affected. Conclusions: Hemorrhage, Eclampsia and sepsis are the major causes of maternal deaths. Improvement in primary health care in rural areas and proper implementation of NRHM programs and up gradation of hospitals in rural areas can definitely bring down the number of maternal deaths.