Objective: to analyze in -hospital maternal case fatality ratio in the postpartum period according to pregnancy risks and route of delivery, within the Brazilian National Health System, Brazil and macro-regions, 2010-2019. Methods: this was an ecological time -series study, using data from the Hospital Information System; inhospital maternal case fatality ratio in the postpartum period took into consideration maternal hospitalizations with outcome 'death' over the total number of hospitalizations per year, according to pregnancy risks and route of delivery, in the regions. Results: there were 19,158,167 hospitalizations for childbirth and 5,110 deaths in the period analyzed; maternal case fatality ratio increased from 1.1 (2010) to 1.9 death/10,000 hospitalizations (2019), in usual-risk pregnancies after vaginal deliveries, and decreased from 10.5 (2010) to 7.0 deaths/10,000 hospitalizations (2019) in high -risk pregnancies after cesarean sections; the Midwest region presented the highest and the South region the lowest case fatality ratio for high -risk pregnancies. Conclusion: in -hospital case fatality ratio was higher for high -risk pregnancies, showing differences according to route of delivery and regions.
