OBJECTIVE Analysis of maternal mortality in the Czech Republic in 1999. METHODS Retrospective statistical and clinical analysis. METHODS Department of Obstetrics and Gynecology of the 1st Medical School of Charles University and General University Hospital, Prague 2; 2. Institute for Care of Mother and Child, Prague-Podoli. METHODS We used database of 10 cases of maternal deaths in the Czech Republic during 1999 to analyze their causes, clinical courses especially related to obstetrical surgery, adequacy of provided care, and characteristics of their occurrence. RESULTS There were total 10 reported maternal deaths in pregnancy, during labor or within 42 days after delivery in the Czech Republic in 1999. During the same period there were 89,471 live births in the Czech Republic, and Pregnancy-related mortality ratio (A + B + C) was 0.11@1000, i.e. 11.2 deaths per 100,000 live births. This is about 0.044@1000 worse than in 1998 (the last table demonstrates the development of maternal mortality during last 9 years). One reported death was unrelated to gestation (category C), therefore adjusted maternal mortality rate (A + B) was 0.10@1000, i.e. 10.1 deaths per 100,000 live births versus 6.63 deaths per 100,000 live births in 1998. Group A (specific risk--direct maternal mortality) contributed to adjusted maternal mortality by 6 maternal deaths and direct maternal mortality was 6.7 per 100,000 live births. Group B (non-specific risk--undirect maternal mortality) contributed by 3 maternal deaths and undirect maternal mortality was 3.3 per 100,000 live births. CONCLUSIONS The increase of maternal mortality in 1999 and forensic impact of some cases indicate the necessity to respect established guideline for obstetrics and gynecology. Currently established complex prophylactic measures to prevent development of thrombembolic complications provede, if fully implemented, possibility to minimize these threatening and formerly very frequent situations leading to death. However, there is ongoing danger of hemorrhagic complications related to the DIC, which despite the modern therapy represent the major factor in maternal mortality and morbidity.