Background: The placenta facilitates vital nutrient exchange between fetus and mother, offering insights into fetal and maternal health. Despite its significance, research on placental histopathology in Tanzania is scarce. This study investigates placental features, maternal factors, and their impact on fetal outcomes at Bugando Medical Centre from January to May 2022. Methods: This 5-month cohort study included 205 mothers delivering at BMC. Fetal outcomes were evaluated at birth and after seven days, with maternal characteristics recorded at delivery. Participants were from the twenty-eighth week of gestation, excluding those with intrauterine fetal death or multiple pregnancies. Data on placental histology, maternal factors, and fetal outcomes were collected systematically, while statistical analysis employed STATA version 15, utilizing descriptive statistics. Results: In this study of 205 placentas, participants had a median age of 29 years and a mean gestational age of 38 weeks. Histopathological patterns were present in 61% of placentas, with acute inflammation (22%) and maternal vascular malperfusion (20.8%) being most common. Favorable outcomes were observed in 81% of newborns, while 19% experienced poor outcomes, including 1.9% early neonatal deaths. Most placental lesions were mild (53.6%), with severe pathology in 2.9% of cases. Acute inflammation correlated with various admission reasons, especially neonatal sepsis (60%). Maternal vascular lesions were associated with prematurity (63.6%) and birth asphyxia (40%). Chronic inflammation was more prevalent among low-birth-weight infants (18.8%), while very low birth weight was common in cases of maternal vascular lesions (68.8%). Conclusion: The majority of placentas showed normal or mild pathology, associated with positive fetal outcomes. Further research is needed to understand placental changes and their impact on maternal-fetal health.