Objective: To investigate factors associated with acute maternal morbidity and mortality in Kowloon Hospital, Suzhou, China. Methods: Data from cases of near-miss and maternal death between January 2008 and December 2012 were reviewed retrospectively. Maternal characteristics and related factors were identified, and multiple regression analysis was used to calculate adjusted odds ratios (aORs) and 95% confidence intervals (Cls). Results: During the study period, there were 18 104 deliveries, 69 near-miss cases, and 3 maternal deaths. Women who had no health insurance (aOR, 4.55; 95% Cl, 0.87-21.8), had fewer than 6 prenatal consultations (aOR, 6.76; 95% CI, 0.76-45.8), were part of a migrant population (aOR, 234; 95% Cl, 0.45-24.9), or delayed seeking healthcare (aOR, 4.76; 95% CI, 0.89-13.6) had a greater risk of near-miss morbidity or death. Admission to intensive care (aOR, 6.75; 95% CI, 0.89-34.6) and blood transfusion within 30 min (aOR, 3.79; 95% Cl, 0.65-8.67) were protective factors in disease progression. Conclusion: The factors associated with maternal near-miss morbidity and mortality were closely related to health insurance and socioeconomic status, suggesting that the government should take an active role in the community in preventing morbidity and mortality in pregnancy. Crown Copyright (C) 2013 Published by Elsevier Ireland Ltd. on behalf of International Federation of Gynecology and Obstetrics. All rights reserved.