Back ground Cesarean section rate is increasing worldwide. However, the World Health Organization has declared that there is insufficient information on maternal outcome following cesarean section for decision making.Objective The aim of this study was to assess post cesarean section maternal outcome and its associated factors availing evidence for practice and policy.Methods Institution based cross-sectional study was conducted among 357 mothers who underwent cesarean section in six selected public general hospitals of Tigray regional State, Ethiopia. Mothers were followed for the duration of post-operative period until they became safe for discharge. The maternal outcomes were categorized into either adverse or good outcomes depending on whether mothers develop any cesarean section related morbidity or not. Logistic regression model was constructed to determine the AOR and 95% CI of independent factors associated with maternal outcome following cesarean section.Results The proportion of adverse maternal outcome was 19.3% with 95% CI of (15.7% -23.8%). Route of anesthesia administration (AOR = 0.296, 95% CI: 0.126 - 0.695) and referral status (AOR = 0.371, 95%CI: 0.214 - 0.641) were statistically significant factors associated with maternal outcome following cesarean section.Conclusion There was high proportion of adverse maternal outcome. General anesthesia and referral from lower health facilities were associated with higher risk of post-CS adverse maternal outcome. Equipping lower level health facilities with the human and material capacity for timely detection of CS indications and provision of cesarean section services could decrease the number of referrals and subsequent delays that lead to adverse maternal outcome.