Maternal deaths remain high, numbers at the facility level are relatively low. Aim: To evaluate the effect of management guidelines on occurrence of maternal near miss in Women's Health Hospital. Design: A cross-sectional study. Setting: ICU of Women's Health Hospital's at Assiut Main University Hospital and Al-fayoum University Hospital. Subjects: Convenient sample of 93 maternal near-miss cases including (Pregnancy or postpartum complications). Tool: audit the applied critical care for severe condition related to obstetric complications and consist of three parts: Patient's demographic data, Audit of critical care and “Maternal near-miss” Fate. Data collected during a period of 1/3/2015 to 30/8/2015 for management guidelines and maternal outcomes. Results: A statistical significant differences between the medical management and occurrence of severe maternal complications such as (severe postpartum hemorrhage, severe pre-eclampsia, Sepsis or severe systemic infection, uterine hemorrhage, ruptured uterus) (P=0.000, P=0.031, P= 0.036, P =0.052, P=0.012 respectively). Conclusions: The maternal management guidelines was a successful tool in recording the gap between the current received management and standards management guidelines in ICU. Also, they measure the effectiveness of current management in ICU on maternal mortality and morbidity.