Introduction: WHO classifies Kenya as having a high maternal mortality. Regional data on maternal mortality trends is only available in selected areas. This study reviewed health facility maternal mortality trends, causes and distribution in Central Region of Kenya, 2008-2012.

Methods: we reviewed health records fromJuly 2008 to June 2012. A maternal death was defined according to ICD-10 criterion. The variables reviewed included socio-demographic, obstetric characteristics, reasons for admission, causes of death and contributing factors. We estimated maternal mortality ratio for each year and overall for the four year period using a standard equation and used frequencies means/median and proportions for other descriptive variables.

Results: a total 421 deaths occurred among 344,191 live births; 335(80%) deaths were audited. Maternal mortality ratios were: 127/100,000 live births in 2008/09; 124/100,000 live births in 2009/2010; 129/100,000 live births in 2010/2011 and 111/100,000 live births in 2011/2012. Direct causes contributed majority of deaths (77%, n=234) including hemorrhage, infection and pre-eclampsia/eclampsia. Mean age was 30(±6) years; 147(71%) attended less than fourantenatal visits and median gestation at birth was 38 weeks (IQR=9). One hundred ninety (51%) diedwithin 24 hoursafter admission. There were 111(46%)caesarian births, 95(39%) skilled vaginal,31(13%) unskilled 5(2%) vacuum deliveries and 1(<1%) destructive operation.

Conclusion: the region recorded an unsteady declining trend. Direct causes contributed to the majority deaths including hemorrhage, infection and pre-eclampsia/eclampsia. We recommendhealth education on individualized birth plan and mentorship on emergency obstetric care. Furtherstudiesare necessary to clarify and expand the findings of this study.