Objective. To determine the prevalence and role of obstetric and extragenital pathology in the structure of maternal mortality based on the results of postmortem. Materials and methods. Analysis of the structure of maternal mortality (MM) in the city of Moscow was based on the data of the Moscow Department of Health (MDH) in accordance with the criteria of the International Classification of Diseases, 10th revision. Overall, 58 autopsy protocols were analysed, medical records provided by outpatient institutions and hospitals under the jurisdiction of MDH were studied. Results. In Moscow. 94 pregnant, parturient, and puerperal women died over the period from 2014 to 2018. Annual MM rates during that period vary from 17.3 per 100 000 live births in 2016 to 12.4 per 100 000 live births in 2018. In general, the MM rate decreased by 1.7 times over the past 18 years, amounting to 43.7 per 100 000 live births in 2001. Despite a reduction of maternal mortality rates in Russia, in Moscow more than a half of cases in the structure of lethal outcomes were due to obstetric pathologies in the past 5 years. The first place is taken by preeclampsia/eclampsia, whose proportion is 37.8%. Most patients had atypical pregnancy, the difficulties of diagnosing this complication are conditioned by the polymorphism of the developing clinical syndromes. Conclusion. Modern approaches to management of pregnant, parturient and puerperal women require targeted and intensive follow-up at all stages of medical care. Attending physicians should have comprehensive knowledge and a high level of competence for early diagnosis and successful treatment of all possible severe complications of pregnancy. © 2020, Dynasty Publishing House. All rights reserved.