To determine the rate of autopsy certification of maternal deaths; evaluate concordance and/discordance rates between autopsy and clinical diagnoses of maternal deaths, and to compare these with findings from other parts of the world. Retrospective study. The Lagos University Teaching Hospital (LUTH), Nigeria between January 1989 and December 1998. Women who died from pregnancy-related complications having been on admission in or having presented as emergencies to LUTH. In the study period, 445 maternal deaths were registered in the LUTH mortuary. Autopsies were performed on 371 of these, giving an autopsy rate of 83.37%. Only 230 cases were found suitable for evaluation of concordance and discordance. Two hundred and six of these (89.57%) had related clinical and autopsy diagnoses (concordance) while 24 (10.43%) had completely unrelated diagnoses (discordance). Adequate investigation of cause of death using the autopsy will assist in accurately determining the sequence of events that result in death and hence provide required statistics for the planning of appropriate interventions.