<![CDATA[Background: Maternal mortality remains a major public health challenge, reflecting the overall performance of maternal health services. Despite global and national efforts, maternal deaths continue to occur, particularly in low- and middle-income countries. Understanding the temporal pattern of maternal mortality and its associated risk factors is essential for informing targeted interventions.Objectives: This study aimed to analyze the association between maternal risk factors and maternal mortality in North Sumatra Province using a survival analysis.Methods: A retrospective cohort study was conducted using maternal mortality surveillance data recorded in the Maternal Perinatal Death Notification (MPDN) system from January to December of 2023. Of the 202 recorded maternal deaths, 140 met the inclusion criteria and were included in the survival analysis. Survival time was defined as the duration (days) from hospital admission to death. Kaplan–Meier estimation was used to assess survival probability, and Cox proportional hazards regression was applied to identify independent risk factors.Results: The mean maternal age was 31.66 ± 6.57 years. Most deaths occurred among multiparous women and those who had fewer than six antenatal care visits. The mean survival time following hospital admission was 1.41 ± 0.56 days, which indicates rapid clinical deterioration. Kaplan–Meier analysis demonstrated a steep decline in survival probability within the first 24 hours of admission. In the multivariable Cox regression analysis, a history of cesarean section was independently associated with an increased mortality risk (HR 8.66; 95% CI 1.95–41.30). However, the wide confidence interval suggests a limited precision.Conclusion: Maternal mortality in North Sumatra predominantly occurs during the early phase of hospitalization. A history of cesarean section appears to function as a marker of clinical severity rather than a direct causal determinant. Strengthening early emergency obstetric response and referral systems is essential for reducing preventable maternal deaths. ]]>
