Please cite this paper as: van Dillen J, Mesman J, Zwart J, Bloemenkamp K, van Roosmalen J. Introducing maternal morbidity audit in the Netherlands. BJOG 2010;117:416–421. Objective  To describe the panel audit process and to identify substandard care in selected women from a nationwide prospective cohort study into severe acute maternal morbidity (SAMM) in the Netherlands. Design  Prospective audit of selected women with SAMM. Setting  Eight audit meetings held throughout the Netherlands. Population  All pregnant women in the Netherlands. Methods  Before each meeting, SAMM details of selected women were sent to all panel members for individual assessment by completing an audit form. During a subsequent plenary meeting, findings were discussed and substandard care factors as judged by the majority of assessors were scored. Main outcome measures  Incidence of substandard care and recommendations for improving the quality of care. Results  Substandard care was identified in 53 of 67 women (79%). Specific recommendations were formulated concerning the procedure of audit and concerning local as well as national management guidelines. Conclusion  Our findings reflect SAMM in the Netherlands and substandard care is present in four out of five women. Ongoing audit of women with SAMM is promoted both at local and national level.