Maternal mortality in high income countries has become low in recent years and therefore analysis of severe acute maternal morbidity has been added to confidential enquiries into the causes of maternal deaths. The major drawback at the moment is the lack of universal definitions of severe acute maternal morbidity. The prevalence of severe acute maternal morbidity in high income countries is between 3.8 and 12 per 1,000 births. Case fatality rates may reflect the quality of maternal health care. Audit is the instrument to analyse whether substandard care factors are present. Guidelines and protocols to provide obstetric critical care may be improved from audit findings and skills and drills training put in place.