BACKGROUND: Placenta previa is a potent risk factor for obstetric hemorrhage, a leading cause of feto-maternal morbidity and mortality in developing countries. In Tanzania, however, placenta previa has not been well-explored. Understanding the predictors and consequences of placenta previa would aid in planning timely and effective interventions. This study aimed to evaluate the frequency of this condition, its risk factors and subsequent feto-maternal outcomes among women who delivered at a referral hospital in Kilimanjaro, Tanzania, from the years 2000 to 2015. METHODOLOGY: A retrospective cohort study was conducted using maternally-linked data from the Kilimanjaro Christian Medical Centre (KCMC) medical birth registry. Women who delivered at KCMC between January 2000 to December 2015 were analyzed; those with multiple gestations or placental abruption were excluded. Data analysis was performed using Statistical Package for Social Science (SPSS) version 20.0. Descriptive statistics were used to summarize categorical variables; Student’s t-test was used to compare maternal age means. Chi square tests were used to determine the association between independent variables and placenta previa, and adjusted odds ratios (ORs) with 95% confidence intervals were estimated using multivariate regression models. A p-value of less than 0.05was considered statistically significant. RESULTS: The prevalence of placenta previa was 0.6%. Independent risk factors for placenta previa were gravidity ≥5 [OR 4.98; 95%CI: 1.5-16.2], antenatal care visits ≥ 4 [OR=0.45; 95% CI: 0.31-0.64], alcohol use in present pregnancy [OR1.59; 95%CI: 1.15-2.18], and history of gynaecological disease before [OR 2.31; 95%CI: 1.4-3.79] and during pregnancy [OR48.7; 95%CI: 4.78-497]. Adverse maternal outcomes associated with placenta previa were: PPH [OR 9.21; 95%CI: 5.3-16], APH [OR 17.6; 95%CI: 8.6-6.2], blood transfusion [OR 2.91 95%CI: 1.87-4.52], long hospital stay [OR 5.62; 95%CI: 3.85-8.2] and Caesarean delivery [OR 9.68; 95%CI: 6.66-14.1]. Associated adverse fetal outcomes included: Apgar scores ≤ 7 at one [OR 2.68; 95% CI: 1.88-3.84], five [OR 3.83; 95% CI: 2.73-5.39] and ten minutes [OR 3.07; 95% CI: 2.08-4.52], birth weight <2.5kg [OR 2.58; 95% CI: 1.55-4.29], fetal malpresentation [OR 4.30; 95% CI: 2.27-8.13], admission to the neonatal intensive care unit [OR 2.53; 95% CI: 1.8-3.57] and early neonatal death [OR 3.75; 95% CI: 1.15-12.3]. CONCLUSION: The prevalence of placenta previa in our population was comparable to that found in past studies. Gravidity ≥ 5, current alcohol use, and history of gynecological disease xii were independent risk factors for placenta previa. Placenta previa was also found to have significant associations with several adverse feto-maternal outcomes. Early diagnosis of placenta previa during prenatal care will help the clinicians manage and prevent such complications. Keywords: placenta previa, prevalence, risk factors, outcomes, Tanzania.