This study investigates the trends and determinants of maternal mortality at the Lagos State University Teaching Hospital (LASUTH), aiming to provide evidence-based insights into maternal health challenges. The primary objective is to analyze patterns of maternal deaths and identify key contributing factors. Existing research highlights gaps in understanding the specific influences of healthcare infrastructure, socioeconomic disparities, and policy interventions on maternal mortality. This study builds on the health system approach and the Three Delays Model to explore the critical determinants of maternal deaths in a hospital setting. A retrospective study design was employed, utilizing hospital records from 2019 to 2024. The study population consists of maternal mortality cases at LASUTH, with data collected through hospital records. A purposive sampling technique was used, and data analysis was conducted using descriptive and inferential statistical methods. Key findings reveal that hemorrhage, hypertensive disorders, and sepsis are the leading direct causes of maternal deaths at LASUTH. Socioeconomic factors such as low education levels, late healthcare-seeking behavior, and financial constraints also play a significant role. The study highlights systemic issues, including delays in accessing emergency obstetric care and inadequacies in healthcare infrastructure. The study concludes that targeted interventions in emergency obstetric services and maternal health education are crucial to reducing maternal mortality. It recommends strengthening healthcare systems, enhancing community awareness programs, and improving policy implementation to address maternal health challenges effectively.