Background: Emergency cesarean section (E/Cs) is one of the most common obstetric procedures worldwide and an increased rate of cesarean section has been observed in recent studies. Maternal and fetal mortality and morbidity associated with cesarean section is an important health problem worldwide. This requires the evaluation of the effect of repeated cesarean delivery on maternal morbidity. The World Health Organization considers (WHO) Cesarean section rates of 5–15% to be the optimal range for targeted provision of this life saving intervention. However, access to safe Cesarean section in resource-limited settings is much lower, estimated at 1–2% reported in sub-Saharan Africa. Objective: To determine prevalence, indicators for emergency caesarian section, maternal and fetal outcomes among pregnant women underwent caesarian section at Kilimanjaro Christian Medical Centre 2013/2014. Methodology: This study conducted at KCMC where secondary data from Medical Birth Registry will be used. To determine prevalence, indictators, maternal and fetal outcomes among pregnant women underwent caesarian section at Kilimanjaro Christian Medical Centre was assessed using logistic regression. Result: From January 2013 to September 2014, a total of 6602 deliveries were performed in Kilimanjaro Christian Medical Centre (KCMC). Among of these deliveries 34.5% (2275) was through ECS. The common leading indicators for ECS among 2027 pregnant women at KCMC are dystocia 26.7% (541), repeated CS 19.2% (389) and fetal indicators 18.4% (373). Majority of parturients (99.8%) survived following ECS while 2% died while among neonates delivered via ECS, majority (97%) survived while only 3% died. Conclusions: Majority of the women who delivered via ECS belong to the reproductive age group 18-35 years, primigravid, multiparous (2-4). Dystocia, repeated CS and fetal indications were the leading indications for ECS at KCMC. The clinical outcome of ECS was favorable for both the mother and the child. Survival was high, 99.8% and 97% for both parturients and neonates, respectively. Similarly, mortality rate was low 2% and 3% for both parturients and neonates respectively.