Dissertation (Master of Medicine in Obstetrics and Gynaecology)Background: Severe Acute Maternal Morbidity (SAMM) auditing is rarely conducted and has never been done in DRRH despite the established fact that SAMM auditing is useful in the prevention of maternal mortality and improve the quality of obstetric care perhaps with better results than just maternal mortality audit as suggested by some published works done elsewhere. Objective: The main objective was to determine the incidence, causes and management outcomes of severe acute maternal morbidity among women admitted at DRRH between September 2015 and February, 2016. Methods: This was a retrospective cross-sectional descriptive study. Medical records of all women who were admitted in the obstetrical wards, gynecological wards, and the Intensive care Unit of the Dodoma Regional Referral Hospital between September 2015 and February 2016 were retrieved and information analyzed. Main outcome measures: Incidence, case fatality rate, and causes. Results: During the study period, a total of 7789 women were admitted to the hospital for various pregnancy-related conditions. Severe Acute Maternal Morbidity was found in 140 cases of all admitted patients giving an overall incidence of 17.9 per 1000 women. Severe pre-eclampsia/eclampsia was the leading cause with 64 cases (45.7%) and an incidence of 8.2 per 1000, followed by major obstetric haemorrhage with 57 cases (40.7%) with an overall incidence of 7.3 per 1000. During this period 16 deaths were recorded among those who were classified as being SAMM cases giving case fatality rate of 11.4%. Substandard care was found in 77 (55%) patients. Conclusions: The incidence of Severe acute maternal morbidity in this facility is high reflecting a high maternal mortality and therefore should be well thought-out locally and country wide as a new indicator of a quality of obstetric care.