INTRODUCTION: Puerperal sepsis is the one of the five leading causes of maternal morbidity and mortality worldwide although most of their risk factors are preventable. Globally it is reported to be 4.4% of live birth but however in USA it occurs between 1-8% of all deliveries and 3 women die from puerperal sepsis / 100,000 deliveries. However it accounts 15% of all maternal death worldwide. Also the study which was done rural District in Morogoro region, Tanzania reported that 35% maternal death are due to the puerperal sepsis. AIM: To determine the risk factors, treatment and outcomes of puerperal sepsis. METHOD: This study was hospital based retrospective cohort study conducted at KCMC Hospital from Jan 2013 to Dec 2015. 155 participants were involved and 93(60%) were cases. The case file were found by reviewing patient’s medical registry files by random sampling strategies. Multivariate statistics were also done. RESULTS: The multivariate analysis showed that women who had anemia [OR=0.021 95% CI (0.003-0.171)], premature rupture of membranes [OR=16.27 95% CI (1.562-169.442)], caesarian section [OR=0.004 95% CI (0.000-0.038)], retain products of conceptions [OR=0.057 95% CI (0.006-0.569)] and episiotomy [OR=0.026 95% CI (0.002-0.269)] were more likely to develop puerperal sepsis. The morbidities found in this study to women with puerperal sepsis were septicemia 8 (8.6%), wound gaping 36 (38.7), peritonitis 14 (15%) and endometritis 5 (5.4%). The most common risk factor and outcome being caesarian section 56 (88.6%) and 36 (38.7%) wound gaping respectively. CONCLUSION: Puerperal sepsis is the preventable and treatable illness therefore time for recognition of the disease is very important for preventive management. The study revealed that there is a set of factors associated with puerperal sepsis among women caesarian section being the leading one. The treatment based on culture remain the only solution to reduce maternal morbidity of the infection rate in KCMC referral Hospital and in Tanzania as a whole.