Maternal mortality is defined as the death of a woman related to pregnancy or childbirth, caused by direct complications, such as hemorrhage and hypertension, or indirect complications related to pre-existing diseases aggravated by pregnancy. Studying these causes is essential to improve care and reduce maternal deaths in the city of São Paulo.To describe the socioeconomic profile of maternal deaths and the maternal mortality ratio by type of obstetric cause in the city of São Paulo, from 2013 to 2023.This is an ecological, descriptive, and quantitative epidemiological study using data from the Mortality Information System (SIM) and the Live Birth Information System  of São Paulo (2013–2023). Sociodemographic data of maternal deaths were included: age group, education, marital status, place of occurrence, and cause of death. To calculate the maternal mortality ratio by cause of death, the number of live births in São Paulo was used, stratified by year. The specific maternal mortality ratio by type of cause was used to construct the time series graph.Maternal deaths in the municipality of São Paulo in the period from 2013 to 2023* occurred predominantly in women aged 30 to 39 years (48.49%), white (46.99%), single (55.21%), took place in hospitals (96.06%), and were due to direct obstetric causes (50.92%). The maternal mortality ratio due to direct causes was higher from 2013 to 2019 and from mid-2021 to 2023. From 2019 to early 2021, the predominant obstetric cause was indirect. Throughout the period, the unspecified obstetric maternal mortality ratio was the lowest among the causes; however, it increased in 2020, similar to the indirect causes.Advanced maternal age and single status indicate social vulnerability and increased risk. The predominance of in-hospital direct causes suggests failures in emergency care. The shift to indirect causes reflects the impact of COVID-19 mortality and health system overload.Maternal mortality in São Paulo between 2013 and 2023 highlights social inequalities and weaknesses in women's health care. The predominance of direct causes and the oscillation during the pandemic reinforce the importance of public policies that guarantee access, quality, and equity in care, especially in prenatal care and childbirth.