Maternal mortality in the United States is an urgent public health concern. Despite advances in medical technology and obstetric care, maternal mortality remains elevated in the United States, with disparate burden across racial or ethnic, socioeconomic, and geographic communities. The reasons for these disparities are myriad and include a confluence of structural and social determinants, variation in medical care access and quality, and individual risk factors. This review explores the evolving patterns of maternal mortality in the United States by examining contributing causes, demographic disparities, and systemic challenges, with an emphasis on the limitations of current US maternal mortality surveillance infrastructure. We highlight the urgent need for data-driven policy interventions, equitable health care reforms, and research innovation to enhance maternal health and eliminate disparities.