Background: Though one way of reducing maternal deaths, is by improving the availability,rnaccessibility and use of services for the treatment of obstetric complications that arise duringrnpregnancy and childbirth; still, few facilities are providing the services. 80% of women are dyingrnfrom direct emergency obstetrics complications.rnObjectives: To assess the availability, patterns of utilization and quality of emergency obstetricrncare services in health facilities as a measure of progress towards maternal mortality reductionrnand set a base line for the zone.rnMethods: A cross-sectional institution based survey was conducted in 12 districts of SouthrnWest Shoa zone of Oromia regional state. Twelve health centers and one hospital were envolvedrnin the study. EmOC facilities` data of one year(January1, 2010-December30, 2010)werernobtained by reviewing obstetric,gynacological and surgical log book. Clients and keyrninformatics were interviewedrnResults : There was one comprehensive emergency obstetric care (CEmOC) facility perrn1,088,06 in the zone. 562 obstetric complication cases were served in CEmOC facility.rn413(80%) of cases were direct obstetric complications which make the met need for EMOCrn6.6% in the zone with the highest for urban (22.4%) where the CEmOC is founded and thernlowest 0.72% for rural district . Among 41,346 estimated deliveries 447 (1.08%) were c/srndeliveries;298(66.7%) were due to absolute maternal indications. The crude direct obstetric casernfatality rate was 14(3.39%) and the causes were: uterine ruptue,PIH, hemmorehge(APH andrnPPH),obstructed labor,and purepureal sepsis in which each cases account forrn4(28.6%),3(21.4%),3(21.4%),2(14.3%),and 2(14.3%) respectively.rnConclusion and Recommandations: Majority of women are inaccessibile to EmOC or lifernsaving services.Although they utilize the EmOC facilty through different difficulities, theyrnencounter startiling facility obstetric case fatality.The supportive supervision list lacks EmOCrnservices. Patients (sepsis and PIH cases) complained high waiting time before adimission. Therernfore,maternal health should not be only political agenda, and quality EmOC services should bernavailable at reasonable place and time. Further studies on emergency obstetric services startingrnfrom health personel pre service training to community level is manidatory