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The aim of this study was to assess outcome of pregnancy in women with one previous caesarean section at Muhimbili National Hospital in Dar es Salaam, Tanzania. A cross sectional descriptive study was conducted at Muhimbili National Hospital (MNH) from 13th September 2006-2nd February 2007. All women with one previous caesarean section coming for delivery at MNH in that period were identified. Data on medical history, socio-demographic and obstetric characteristics, decision on mode of delivery, and pregnancy outcomes were collected. There were 3285 deliveries during the study period, out of which 365 (11%) women had one previous caesarean section. Almost half (48%) of the women with one previous caesarean section attended antenatal care in the dispensaries and health centres. Trial of scar was decided in 80 (21.9%) women. A total of 278 women had the decision for repeat caesarean section made on admission whereby 180 (64.4%) were for emergency caesarean section and 98 (35.6%) were for elective caesarean section. A total 52 women delivered vaginally, 44 after trial of the scar and eight among women decided for emergency repeat caesarean section on admission. The incidence of uterine rupture was 2% and perinatal mortality ratio was 55 per 1000 live birth. In conclusion, a significant proportion of women delivering at MNH had one previous caesarean section among which few underwent trial of scar. Half of the women attended antenatal care in the dispensaries and health centres. Women with previous caesarean section should be encouraged to attend hospitals providing comprehensive emergency obstetric care. The quality of intrapartum monitoring should be audited to improve maternal and newborn outcome.