Introduction: Caesarean section (CS) is one of the commonest lifesaving procedure for childbirth to both mother and child worldwide.. The WHO recommends the prevalence of CS of 10% - 15% per hospital. Globally the prevalence of CS has been reported to be 33%. However, the CS in Sub-Saharan Africa is still low ranging from 1% - 2%. It also varies between and within countries. The prevalence of CS in Tanzania is 5% among all deliveries which also varies between urban and rural hospitals (10% vs 3%) respectively. CS has shown to reduce the maternal and fetal morbidity and mortality when appropriately used, thus utilization of CS in Sub-Saharan Africa including Tanzania where there is high maternal/fetal morbidity and mortality rate may be of great importance. However it is important to note that CS has shown to have no added benefits if inappropriately done. Despite of these facts, there are scant information on prevalence, indications and short-term maternal and fetal outcomes of CS in Tanzania particularly in primary hospitals. Understanding these information may help to accelerate the achievement of SDG3 for improved maternal and newborn health. This study aimed to determine the prevalence, indications, short-term maternal and fetal outcomes, as well as factors associated with adverse maternal outcomes of women who delivered at Mkomaindo district Hospital in Mtwara region, Tanzania. Methodology: A cross-sectional analytical study was conducted at Mkomaindo hospital from June to July 2016. Files of 3033 women who delivered at Mkomaindo hospital in the year 2015 were obtained. A standard data extraction sheet was used to collect relevant information from all participants. Women with incomplete records and those who were below 28 weeks of gestation age were excluded. Data analysis was performed using SPSS version 23.0. Odds ratios with 95% confidence intervals for short-term maternal outcomes associated with CS were estimated in a multiple logistic regression models. A P value of less than 5% (2tails) was considered statistically significant Results: Proportion of CS was 18.6%. Cephalo-pelvic disproportion (43.1%) and previous scar (97.9%) were the commonest indications for Primary and repeat CS respectively. Unemployed women (OR 1.69, 95% CI: 1.09-2.63); were associated with increased odds of having adverse maternal outcomes, while having ≥ 5 parity and ≥ 4 ANC visit (OR 0.28, 95% CI: 0.09-0.80; OR 0.56, 95% CI: 0.32-0.51) respectively was associated with decreased odds of adverse maternal outcomes. The most common adverse maternal outcomes were hospitalization for more than 3 days (64.5%), wound sepsis (61.8%) and hemorrhage (blood loss of > 1000ml) (10.7%). About 10.5% of neonates born by CS were premature. Conclusion The use of CS at Mkomaindo District Hospital is above the WHO recommendations. A number of risk factors for CS and poor maternal outcomes were identified. Knowledge of these factors may reduce unnecessary CS use and promote early intervention in at-risk individuals.