Dissertation (MSc Midwifery)Background: There is increasing rate of umbilical cord abnormalities that put a pregnant woman at the risk of operative delivery, perinatal complications and adverse new born outcomes. Therefore, morphological variations in structure of this vital structure could determine the obstetrics outcomes. Despite the umbilical cord being considered to contribute to obstetric outcome, practice of examining it in Africa even globally is limited. The aim of this study was to assess predictors of umbilical cord morphology and associated fetal and maternal outcomes among women giving birth at Mwananyamala Regional Referral Hospital. Methods: Design: A cross-sectional study of 384 women giving birth in labor ward at Mwananyamala Hospital, Dar Es Salaam. Both descriptive and inferential analysis was conducted, sample was collected immediately after delivery, and assessed for its length by non-elastic tape measure, birth weight obtained through sensitive weighing scale, twisting pattern identified by counting number of coils/spirals per 5cms taken at proximal part of the cord and number of blood vessels by counting. Questionnaire and checklist was used for data collection. Results: Indicated that women who smokes cigarettes were 3 times more likely to have a short cord than to have normal cord length (AOR=2.805, 95%CI 6.477- 32.935 P < 0.001), Women diagnosed with DM were 2 times more likely to have neonate with long cord relative to normal cord (AOR 2.387, 95% CI 1.304-6.495, P< 0.05), and CS found to be two times more likely in short cord relative to long cord. (AOR 2.113, 95% CI: 00.028-0.451, p < 0.05). Conclusion: In this study it has been found that significant association exist between umbilical cord morphology particularly length with fetal and maternal outcome, among the different sizes of the umbilical cord.