The completeness of maternal death reporting in Washington state was determined by comparing death certificates to the birth and fetal death records for women, age 15 to 45, dying from selected causes. From 1977 to 1981 there was 112% underreporting of maternal deaths. Only 17 of 36 maternal deaths were able to be identified on death certificates as being pregnancy related. Of the 36 deaths, two major causes of death were identified: Hypertensive disorders of pregnancy (13 deaths) and pulmonary embolism (six deaths).