Dissertation (MSc Midwifery)Background: Tanzania is among the countries with a high maternal mortality rate worldwide. This burden is said to be contributed by the delay in accessing health care services largely due to failure in recognizing the obstetric danger signs. Objective: To assess the knowledge as a predictor of timely response to pregnancy danger signs and the associated obstetric outcome among high risk post-delivery women in Dodoma region. Methods: A cross sectional study of 289 high risk post-delivery women randomly selected from 4 Hospitals in Dodoma region. The knowledge level on pregnancy danger signs was measured by 10 questions from the tool adopted and modified from safe motherhood questionnaire developed by maternal and child health programme of JHPIEGO (2004) and to identify obstetric outcome patient files and MTUHA BOOK were used. Both descriptive and inferential analysis were conducted Results: Knowledge on pregnancy danger signs was found to be low i.e (58.8%) 170.The majority, i.e. (72.3%) 209 were revealed to respond to experienced danger signs, although prevalence of type 1 delays was 51.6 % (149), on multivariate analysis knowledge on pregnancy danger signs was revealed to be a good predictor of type 1 delays (AOR=0.030, P< 0.05, CI: 0.012, 0.071), but not a predictor for appropriate response and associated undesirable obstetric Outcomes. Maternal age (AOR=0.445, P< 0.05, 95%CI: 0.119, 0.995), maternal education (AOR=0.378, P< 0.05, CI: 0.161, 0.892) paternal education (AOR=3.925, P< 0.05, 95% CI: 0.1.768, 8.714), and parity (AOR=0.526, P< 0.05, 95%CI: 0.297, 0.932). 149 (51.6%) were found to have statistical significant on knowledge of pregnancy dangers signs. Conclusion Delay in accessing obstetric care and undesirable obstetric outcomes are prevalent in the study area. Low knowledge on obstetric danger signs predicted delay in accessing obstetric care which ultimately results in poor obstetric outcomes. Therefore extra effort must be extended to address knowledge gap among women of reproductive age.