Objective: To determine the trend, causes and characteristics of matal deaths in a tertiary hospital in north Tanzania. Methods: A descriptive retrospective review of hospital based matal death data that occurred at Kilimanjaro Christian Medical Center (KCMC) between the years 2003 to 2012. Descriptive statistics were used to summarize the socio-demographic characteristics, causes and risk factors for matal deaths using STATA version 12. Yearly matal mortality ratio was calculated to estimate the trend over years under the review. Results: Between years 2003 to 2012, a total of 34953 live deliveries and 172 matal deaths were recorded at KCMC, giving an overall MMR of 492.1/100000 live deliveries. Direct causes accounted for 107(62.2%) of matal deaths, indirect causes 49(28.5%) and 16(9.3%) were due to both direct and indirect causes. Hemorrhage was the overall leading cause of matal death, accounting for 33(19.2%) of mortality, followed by hypertensive disorders in pregnancy 31(18.0%). HIV/AIDS and heart diseases accounted for 8.7% and 6.4% of matal deaths, and were the leading causes of indirect matal deaths by contributing 31% and 22% respectively. Majority 67(38.9%) of deaths were attributed to type II delay followed by type I delay 59(34.3%). Conclusions: Matal mortality ratio is still very high in north Tanzania with hemorrhage and hypertensive diseases the major preventable causes of deaths. Efforts must be made at the community, lower and tertiary health facilities to improve risk detection, management of risk cases to prevent severe forms of diseases and ensure timely referrals.