BackgroundAssessment of severe maternal morbidity is increasingly being undertaken to understand the aetiology and factors which lead to adverse maternal outcomes. Their use in conjunction with maternal deaths may allow a comprehensive assessment of care provided, highlight areas for improvement within the health system and allow benchmarking of care against other institutions. Timor‐Leste has one of the highest rates of maternal mortality in the Asia‐Pacific region; however, there has been limited research into the level of severe obstetric morbidity in the country.AimTo determine the aetiology and rates of severe obstetric morbidity and mortality at Hospital Nacional Guido Valadares, Timor‐Leste.Methods and MaterialsCases of maternal ‘near misses’ and deaths were prospectively identified over a period of 12 months using the World Health Organization maternal near‐miss criteria. Cases of maternal death and near miss were combined (severe maternal outcomes) for descriptive analysis.ResultsDuring the audit period, 69 severe maternal outcomes were identified: 30 maternal deaths and 39 ‘near misses’. The maternal mortality ratio and the maternal near‐miss ratio were 662/100 000 live births and 8/1000 live births, respectively. The main identified obstetric aetiologies were haemorrhage and pre‐eclampsia, while 22% of severe maternal outcomes did not have a clearly identified cause.ConclusionThe high institutional maternal mortality ratio requires urgent attention and identification of areas for improvement. Auditing and benchmarking using the WHO near‐miss criteria provide a mechanism for standardised comparison of obstetric care but require further refinement to the local context.

Background Timor‐Leste has one of the highest perinatal mortality rates in the Asia‐Pacific region. Consistent and accurate data collection improves understanding of perinatal outcomes and facilitates the development of interventions to reduce stillbirths and early neonatal deaths. Aims (1) To identify changes in the rates of stillbirth and early neonatal deaths from previous published data. (2) To determine if prospective data collection and the application of the simplified Causes Of Death and Associated Conditions (CODAC) classification allows better identification of perinatal deaths in Timor‐Leste. Methods A prospective audit of perinatal deaths of women delivering at Hospital Nacional Guido Valadares (HNGV) was undertaken from January to June 2016 inclusive. The hospital birth registry, maternal and neonatal records were reviewed to determine the most likely aetiology and classification of perinatal deaths using the simplified CODAC system. Results One hundred and ten stillbirths and 28 early neonatal deaths were identified. Fifty‐four percent of perinatal deaths occurred antepartum, 26% intrapartum and 20% were early neonatal deaths. Cause of death among stillbirths could not be ascertained in 40% of cases. Intrapartum asphyxia was the commonest identified aetiology of intrapartum and early neonatal deaths. Conclusion There has been limited improvement in the rate of stillbirths and early neonatal deaths at HNGV. Intrapartum hypoxia and maternal hypertensive conditions were the most common identified aetiologies highlighting areas where targeted interventions may help reduce high perinatal mortality rates. Aetiology of perinatal deaths, particularly antepartum stillbirths was difficult to discern even when well‐tested classification systems are used.