Background
Assessment 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.

Aim
To determine the aetiology and rates of severe obstetric morbidity and mortality at Hospital Nacional Guido Valadares, Timor‐Leste.

Methods and Materials
Cases 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.

Results
During 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.

Conclusion
The 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.