Materials and Methods: This cross-sectional study was performed in all 21 community health centers in Bima Regency in 2025. A total of 655 MCH handbooks were selected using proportional random sampling to assess the preeclampsia screening documentation. All 30 physicians were included to assess knowledge levels using a validated questionnaire. The occurrence of preeclampsia-related maternal deaths was categorized by health center. Analyses included chi-square, independent t-test, and Mann–Whitney U test. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.

Results: Overall, 70.4% of MCH handbooks had complete preeclampsia risk screening. Sixteen physicians (53.3%) demonstrated poor knowledge (score < 85). The median completeness score was significantly lower in health centers with maternal deaths compared to those without (44.19 vs. 92.00; P = 0.045). A counterintuitive association was observed where physicians with poor knowledge were less likely to be in centers with maternal deaths (OR: 0.089; P = 0.031; 95% CI: 0.009–0.873). This inverse association may reflect post-audit knowledge improvement, as maternal death audits preceded the knowledge assessment.

Conclusions: Incomplete screening documentation is associated with higher maternal mortality. The association between physician knowledge and mortality appears confounded by reverse causality, as knowledge was measured after post-maternal death audits. Regular evaluation and targeted continuous training remain important to strengthen preeclampsia risk detection and support efforts to reduce maternal mortality.