Background: Peripartum hysterectomy (PH) is the removal of the uterus partially or totally after vaginal delivery or during caesarean section procedure. The procedure is mostly done, as emergency measure to save a life of peripartum woman. The incidence of peripartum hysterectomy has a wide range between 0.24 and 8.7 per 1000 deliveries. The maternal morbidity and mortality due to PH are ranging from 26.5 to 31.5% and from 0 to 12.5% with a mean of 4.8% respectively. There are limited study reports in Africa to evaluate and report the incidence and outcome of peripartum hysterectomy and in particular Tanzania. Determination of incidence, risk factors and immediate post-operative complication of Emergency Peripartum Hysterectomy (EPH) provides informations on the quality of emergency obstetric care. We assessed the incidence, risk factors and immediate post operative’s complications through a retrospective case control study using data collected from the year 2000 to 2012, at KCMC in Tanzania. Methods: KCMC birth registry was used to match cases versus control in ratio of 1:2.Matching was based on initial planned mode of delivery, such as SVD + EPH vs SVD alone,SVD + CS+EPH vs SVD+CS alone, VE+EPH vs VE alone ,Elective CS+EPH vs Elective CS alone. The total numbers of cases were 126, while controls were 252, making a total of 378 study participants. The study sample was developed from all patients seen at KCMC as from the year 2000 to 2012. Chi-Square test and logistic regression analysis were used to determine the risk factors associated with EPH. vi Results: Of the 45,388 births recorded during study period, there were 167cases of EPH, which gave the incidence of 3.679/1000 deliveries. Maternal age above 35 years aOR 3.30 (95% CI 1.49 – 7.28), parity ≥1 aOR 17.90 (95 % CI 6.17 – 51.92), twin pregnancy aOR 9.51 (95 % CI 2. 1.60 – 56.32), GA ≥ 37 weeks aOR 20.75 (95% CI 9.32 – 46.20) were significantly associated risk factors for EPH. As well having CS for abruption placenta OR 46.7 (95% CI 12.4-176.7), placenta praevia OR 14.4 (95 % CI 3.8-54.9), patient with previous uterine scar OR 5.3,95 % 1.9-14.8) and failures of trial of scar OR 3.9 (95% 1.2-12.4) were significantly associated with EPH. Common immediate post operatives’ complication were blood transfusion (81.7 %), ICU admission (32.5 %), oliguria (18.3 %), severe anemia (10.3%) and fever (5.5%).Bladder and ureteric injuries were (2.4 %) and (4.0 %) respectively. Maternal mortality was 13.5 %. Conclusion: Emergency peripartum hysterectomy is a life saving procedure. But, it associated with high rate of morbidity and mortality. In fact; it has some risk factors that can be anticipated to reduce morbidity and mortality.