Hypertensive disorders of pregnancy (HDP) are the commonest medical complication in pregnancy, and remain the commonest direct cause of maternal mortality in South Africa. (1) The latest (2005 2007) Saving Mothers report (SMR) indicates that there were 622 maternal deaths from HDP during this period, virtually the same as in the 2002–2004 report. (1,2) Numbers of deaths reported in the two previous SMRs were 507 for 1999–2001 (3) and 628 for 2002–2004; (2) these differences probably indicate under-reporting in the triennium 1999–2001. The most recent reports, 2002–2004 (2) and 2005–2007, (1) better reflect the numbers of maternal deaths from HDP. Maternal deaths in South Africa are notifiable to the Department of Health (DoH) and are reported in a structured ‘Maternal death notification form’, which contains demographic data and clinical details surrounding the primary and secondary causes of death. This form, together with a copy of the hospital records, is sent to the provincial Maternal, Women and Child Cluster, which has trained assessors (an experienced maternal health specialist and a midwife) to formulate a confidential opinion on any sub-standard care based on patient-related, administrative and health personnel-related factors. Assessments are collated every 3 years and published as the SMR, which includes recommendations to reduce maternal deaths.