Objective: To evaluate the risk of maternal death following the intensification of Maternal and Perinatal Death Surveillance (MPDSR) activities and the substitution of dinoprostone for misoprostol for labour induction. Design: Case-cohort Setting: Kiambu County Referral Hospital(KCRH), Kiambu County, Kenya Population or Sample: Mothers delivering at KCRH during January 2018 - December 2021 Methods: We recruited all 58 mothers who died between January 2018 and December 2021 as cases. A random subcohort of 232 mothers who did not die was selected from a retrospective cohort study of 411 mothers as controls. Multiple logistic regression was used to model the determinants of maternal mortality adjusted for intensified MPDSR activities and labour induction agents. Main Outcome Measures: Adjusted odds ratio of maternal mortality for mothers induced with misoprostol versus dinoprostone and for delivery prior to and after the intensification of MPDSR activities. Results: Factors associated with increased risk maternal mortality included: unemployment (AOR 1.83; 95% C.I.: 0.52 – 7.50), singlehood (AOR 3.47; 95% C.I.: 0.59 – 17.9), labour induction with misoprostol (AOR 7.17; 95% C.I.: 0.72 - 182), multiparity (AOR 3.11; 95% C.I.: 1.37 – 6.98, p = 0.006), or being pre-term (AOR 4.79; 95% C.I.: 1.56 – 15.7, p = 0.007). Conclusions: The risk of maternal mortality did not decrease with the intensification of MPDSR activities but increased with the use of misoprostol to induce labour. Funding: Ministry of Health (Kenya), Transforming Health for Universal Health Coverage