A maternal near miss (MNM) event is a severe life-threatening maternal morbidity that reflects quality of obstetric care. It is considered a proxy of maternal mortality and predictor of quality obstetric care. The major underlying causes of MNM are hypertensive disorders, obstetric hemorrhage, sepsis and abortion complications. MNM is a more frequent event than maternal mortality and share several features together. Inquiries intodeficiencies andcritical assessment of health care quality, identify health system deficiencies, and help develop robust strategies for maternal care. We conducted a cross-sectional descriptive study to determine the prevalence and underlying causes of MNM. The study respondents were women aged 15 - 49 years with pregnancy experience in 2020 who had health facility care. Primary and secondary data were collected at households and health facilities respectively using electronic platform, KoBoCollect. STATA version 15.0 was used to analyze the data. The prevalence of MNM was 11.30%. The main underlying causes were complications of caesarean section, hypertensive disorders, anemia, obstructed labor, and antepartum hemorrhage. The main signal functions of emergency obstetric and newborn care (EmONC) employed to avert death were parenteral antibiotics, blood transfusion, caesarean section, and magnesium sulphate. The prevalence of MNM in the Upper East region was high. The region can reduce severe maternal morbidity and mortality by strengthening health systems, improving access to high-quality obstetric care and training healthcare providers to prevent and treat the major underlying causes of MNM identified in this study. Keywords: Ghana, MNM, Mortality, Prevalence, Antepartum, Hemorrhage, EmONC.