Background: Maternal deaths remain a major public health problem worldwide. The World Health Organization (WHO) has recommended the use of modified WHO partograph to monitor labour and delivery, in order to improve delivery care and reduce maternal and perinatal mortality rate. Objective: This study was aimed to assess utilization of partograph and factors associated with perinatal outcomes among women who delivered at wolaita sodo university teaching referral hospital.Methods: A facility based cross-sectional study was conducted from September 10_25, 2015 by conducting partograph review. A total of was 309 partographs were included in the study by using simple random sampling technique from the total frame of women who gave birth in the last one year and whose delivery was followed by partographs. A Pre-tested and structured checklist was used to collect data. Discriptive analysis was conducted and tables and graphs and summary statistics were used to depict data. Binary logistic regression analysis was conducted to check for variables that show association with neonatal outcomes at P value of 0.05. Finally, multiple logitic regression was conducted to identify factors independantely associated with fetal outcomes. Odds ratio with 95% Confidence interval was used to claim for statistical significance. Results: Out of 309 total of charts reviewed, only for 58%, 3.2% and 2% of mothers monitoring of fetal heart rate, liquor status and molding was done respectively. Labour parameters (cervical dilation, station and uterine contractions) were monitored to the standard in 155(50%), 12(3.9%) and 170(55%) respectively. Apgar score at 5 th minute was ≥7 in 268(86.7%) neonates and resuscitatation was done in 65(21%). 46(14.9%) of neonates were admitted to Neonatal Intensive Care Unit (NICU) for special. Most of the mothers 287(92.9%) had good outcome and only 22(7.1%) of them developed immediate adverse outcomes: There were significant association (p<0.05) between perinatal outcomes and factors like neonatal resuscitations, Apgar score at 1 st minute and liquor quality.Conclusion: This study showed poor quality of partogragh utilizations; despite good perinatal and immediate maternal outcomes. Hence, responsible departments and offices should be encouraged to ensure proper partograph utilization.