Aim and background: Globally one mother dies every 2 minutes from preventable causes related to pregnancy. This implies approximately 800 mothers dying daily, or a maternal mortality ratio (MMR) of 223 maternal deaths per 1,00,000 live births, which is far removed from the UN sustainable development goal (SDG) target to reduce the global MMR to less than 70 deaths per 1,00,000 live births by 2030. The present study was conducted to determine the MMR at a tertiary care hospital and to identify the causative factors leading to maternal mortality. Materials and methods: This retrospective, observational study was conducted in the Department of Obstetrics and Gynecology, Goa Medical College, from January 2015 to May 2024. The data were collected from the Facility-based Maternal Death Review Forms developed under the Maternal Death Surveillance and Response (MDSR) program of the Government of India. All obstetric patients who expired within 42 days of delivery at Goa Medical College were included in the study. Results: The MMR during the study period was 244 per 1,00,000 live births which is higher than the present national average of 97 per 1,00,000 live births The primary causes of maternal mortality were sepsis (32%), hemorrhage (21%) and hypertensive disorders of pregnancy (16%). The commonest demographic factors associated with maternal death were age-group 21–29 years (47%), multiparity (53%) and booked status (87%). While the majority of mothers who eventually succumbed were admitted to the index institute antenatally (59%), more maternal deaths were found to occur postnatal period (60%). About 41% of the referrals were from subdistrict and district hospitals. Around 85% of cases referred from other hospitals were clinically unstable at admission and required admission to the intensive care unit (ICU). Type I delay was the commonest type of delay identified (40 cases). The admission to death interval and delivery to death interval was less than 24 hours in 38% and 28% of cases, respectively. Conclusion: Despite tremendous strides in antenatal coverage and institutional births, the MMR in the state of Goa remains frustratingly static. Sepsis, hypertension and hemorrhage remain the three cardinal causes of maternal death. There is a need for a renewed emphasis on the quality of antenatal care provided. Emphases on early diagnosis and referral of high-risk pregnancies in the antenatal period coupled with vigilant monitoring in the postpartum period is indeed the need of the hour. There is also a need to set up obstetric high dependency units at district and subdistrict hospitals to reduce the number of referrals and thus ease the burden on resources at the tertiary care center. Finally, from a broader perspective, a concerted effort on social development and gender equality is a must in our battle against this evil. Clinical significance: This study was thus conducted to analyze the maternal deaths at this Tertiary Care Center and hopefully avert such tragedies from recurring. Also, to the best of our knowledge, this is the first study on maternal mortality in the state of Goa to be published in literature. The findings of this study can be used to guide decisions regarding allocation of resources and funds, apart from helping plan future research projects in our quest to eliminate maternal mortality.