Severe maternal morbidity remains a public health issue in developing countries. We report in this retrospective study, patients' characteristics and frequency of pathologies responsible of severe maternal morbidity.Between January 1999 and December 2003, 119 cases of severe maternal pathologies of pregnancy and delivery occurred among 19,736 live births.Severe maternal morbidity was 602.95 per 100,000 live births and obstetrical haemorrhages were the most frequent cause (39%) followed by hypertensive disease (25%). Maternal mortality rate was 30.4 per 100,000 live births, and hypertensive disease represents the first cause of mortality in our study, contrary to all Tunisian data where haemorrhage remains the first one.Improvement of prognostic of high risk pregnancies has allowed diminution of maternal mortality. Instead of this diminution, efforts must be done in the management of severe obstetrical pathologies responsible of high maternal morbidity notably complications of hypertensive disease.