Background: The fifth Millennium Development Goal aims for a decrease in maternal mortality and universal access to high-quality reproductive health care. Every year, around a third of a million women die as a result of pregnancy-related complications. Three-quarters of these deaths might have been avoided. One of the most important markers of mother and child health care is the Maternal Mortality Ratio. One of the most significant aims of the national family welfare program is to reduce maternal fatalities are thought to be preventable. Objective: The study's focus is to document, investigate, and report the events and circumstances behind maternal fatalities, as well as to study maternal deaths in River Nile State in order to identify the maternal mortality rate and causes of death. Methodology: This is a hospital and community-based research that took place from January to December 2018 at River Nile State. Information on every maternal death was obtained using a questionnaire which was filled out and rechecked to completely cover State, and then analyzed using SPSS version 20. Results: The overall number of live births was 25988, with 29 incidents of maternal death. 112/100000 live births was the death rate. 27 of the patients (93%) died in a hospital, whereas two instances (7%) died at home. Obstetric hemorrhage was the leading cause of maternal death in seven cases (24.1%), followed by hypertensive disorders in seven cases (24.1%), sepsis in four cases (17.2%), indirect obstetric causes in three cases (10.3%), embolism (PE & AFE) in three cases (10.3%), unclassified causes in four cases (13.7%), and abortion in one case (3.4 %). The bulk of the cases were delayed at home (14 cases, 48.3%), with 10 cases (34.4%) having no delay and five (17.2%) being delayed in reaching hospitals. Unfortunately, 19 instances (65.5%) died as a result of preventable causes. Conclusion: In 2018, the maternal death rate in River Nile State was 112/100,000 live births, which was higher than in the previous report. Maternal fatalities were mostly caused by hemorrhage, hypertensive diseases, and sepsis. The bulk of deaths were postponed until they reached their final destination.