Introduccion : la vigilancia de la morbilidad materna extrema es una estrategia institucional valida como mecanismo para impactar sobre las tasa de mortalidad materna y mejorar los desenlaces perinatales de las pacientes obstetricas criticamente enfermas. Objetivos: estimar la incidencia de la morbilidad materna extrema (MME) e indicadores de atencion obstetrica derivados de la misma. Metodologia: estudio descriptivo, retrospectivo en pacientes obstetricas atendidas en el servicio de obstetricia de la Clinica Universitaria San Juan de Dios, Cartagena, Colombia, en el periodo comprendido entre enero 1 y diciembre 31 de 2010. La seleccion de la muestra se baso en la busqueda de pacientes con diagnostico de condiciones potencialmente fatales o diagnosticos trazadores de MME. El registro de la informacion se llevo a cabo en las fichas de notificacion de MME del Ministerio y posteriormente se sistematizo en una base de datos en el programa Microsoft Excel® 2007. Resultados: se presentaron 3889 nacimientos con 230 casos de mujeres con condiciones potencialmente fatales, para una razon de 59.1 por 1000 nacimientos. Las mujeres tenian una edad promedio de 26.8±4.7 anos. 61 mujeres cumplieron criterios de MME. 56% de las pacientes que cursaron con el evento pertenecian al regimen contributivo de seguridad social. 88.1% de las pacientes cumplieron criterios de intervencion siendo el ingreso a UCI el mas frecuente (68.5%). Las adolescentes presentaron 3.3% mas MME que las adultas. La causa mas frecuente de morbilidad fue la hemorragia asociada al embarazo. Trastornos hipertensivos en segundo lugar y sepsis en tercero. Se presento una mortalidad materna en cada grupo de patologia. Se establecio relacion criterio/ caso de MME de 3.1, con una razon de mortalidad materna de 76.7/100.000 nacidos vivos, asi como una razon de MME de 15.6/1000 nacidos vivos. Conclusiones: se presento una tasa alta de mortalidad materna, por encima del promedio nacional. La hemorragia obstetrica fue el principal evento generador de MME. Rev.cienc.biomed.2012;3(2):291-299 PALABRAS CLAVES: Morbilidad materna extrema; Mortalidad materna; Obstetricia. SUMMARY Introduction: The vigilance of the extreme maternal morbidity is a valid institutional strategy as mechanism to impact on maternal mortality rate and to improve the perinatal outcomes of obstetric patients that are critically ill. Objective: To estimate the incidence of extreme maternal morbidity (EMM) and indicators of obstetric attention derived from it. Methods: Descriptive and retrospective study in obstetrics patients that were seen in the service of gynecology of the Clinica Universitaria San Juan de Dios, Cartagena, Colombia, in the period between January 1st and December 31st of 2010. The selection of the sample was based in the search of patients with diagnosis of potentially fatal conditions or tracers diagnoses of EMM. The register of the information was carried out in the notification cards of EMM of the ministry and subsequently it was systematized in a database in the program Microsoft Excel® 2007. Results: 3889 births were presented in the institution, 230 cases were women with potentially fatal conditions, for a ratio of 59.1 per 1000 births. Women had an average age of 26.8±4.7 years old. 61 women achieved criteria of EMM. 56% of the patients who had the event belonged to the contributory regime of social security. 88.1% of the patients achieved intervention criteria, being the admission to ICU the most frequent of them, (68.5%). Adolescents presented 3.3% more EMM than adult. The most frequent cause of morbidity was hemorrhage associated to pregnancy, in the second place were hypertensive disorders and in the third place was sepsis. A maternal mortality by each group of pathologies was presented. There was established a relation criterion/case of EMM of 3.1, with a maternal mortality ratio of 76.7/100.000 born alive, just like a EMM ratio of 15.6/1000 born alive. Conclusions: A high rate of maternal mortality was presented, over the national average. Obstetric hemorrhage was the main generator event of EMM. Rev.cienc. biomed.2012;3(2):291-299. KEYWORDS Extreme maternal morbidity; Maternal mortality; Obstetrics.