Dissertation (MMED Obstetrics and Gynecology)Background: Placenta and umbilical cord are highly specialized organs of pregnancy which support the normal growth and development of the fetus. Any alteration in gross anatomy of the placental appearance, location, number of cotyledons, weight, thickness and circumference and umbilical cord length, entanglement, nuchal cord, cord knots, thickness, insertion and number of umbilical blood vessel may result into adverse fetal outcome such as birth weight, Apgar score and fetal status. The gross anatomy of placenta and umbilical cord are routinely not examined. Objective: The study intended to determine anatomical pattern of placenta and umbilical cord in relation to fetal adverse outcome at Dodoma Regional Referral hospital. Methodology: It was a quantitative cross-sectional study involving pregnant women admitted in labor ward. It employed simple random sampling technique by lottery method to recruit sample size of 300 term single tone pregnant women without no comorbidities. A structured questionnaire and sonoscape E2 ultrasound machine with color Doppler system were used to collect data and SPSS program version 21 was used during data entry and analysis. Result: In this study majority of participants were aged between 21-30 years with the mean age of 25.46 and the median age of 23.00 ±7.017. BMI, cord length and cord entanglement were significantly associated with fetal status (P<0.05). Also it was found that BMI, placental appearance, cord entanglement and cord length were significantly associated with Apgar score (P<0.05).Furthermore BMI, parity, number of cotyledon, placental shape and placental circumference were significantly associated with birth weight (P<0.05). Conclusion and recommendations: A study revealed that, abnormalities of the gross anatomical pattern of placenta and umbilical cord are significant contributors to fetal outcomes. So efforts prior to and during pregnancy to prevent stillbirth, low Apgar score and abnormal birth weight will be most effective in conjunction with effective monitoring interventions in pregnancy.