Hypertensive disorders of pregnancy (proteinuric hypertension, eclampsia, chronic hypertension, HELL P syndrome) are the commonest direct causes of maternal deaths in South Africa. Six hundred and twenty-eight (19.1%) of the 3 406 maternal deaths in a three-year period (2002-2004) were associated with hypertensive disorders of pregnancy. Cerebral complications, mainly cerebral haemorrhage, were the pathological causes of death in approximately 50% of the cases and eclampsia (convulsions in pregnancy associated with high blood pressure) was the commonest clinical condition leading to death from hypertension. Avoidable factors, missed opportunities and substandard care in all three categories of patient-related, administrative, and healthcare-related components were found by the assessors of the National Committee on Confidential Enquiries into Maternal Deaths to be prevalent in the majority of the deaths. Prevention of complications by lowering high blood pressure fairly rapidly, early referral of high-risk cases to experts in the field, and the proper use of resuscitation skills should reduce maternal mortality associated with hypertensive disorders of pregnancy.