Background: Globally, 370,000 children become newly infected with Human Immune Virus. Mother to child transmission of Human Immune Virus (HIV)is responsible for 90% of child hood infections. HIV counseling and testing of women in reproductive age is an entry point for preventing mother to child transmission of HIV. However, in South Gonder zone limited evidence exists regarding the extent of prevention of mother to child transmission service utilization. Objective:To assess prevention of mother to child transmission services utilization and associated factors among pregnant mothersinSouth Gonder zone, North West Ethiopia, 2019. Methods: Institution based cross-sectional study design was employed among 525 pregnant women attending antenatal care services at public health facilities in South Gonder zone.Multistage sampling technique was used to select study participants. One urban and 3 rural wordas were selected by simple random technique. Among these wordas 6 health facilities was selected. Finally the sample size was proportionally allocated.Interviewer administered questionnaire was used to collect data.Exit interviews were conducted among women attending antenatal care services.The collected data were coded and entered in epi-info.Then data were exported to SPSS version 23.Binary logistic regressionwas used to identify competent variables for multivariable logistic regression analysis. Multivariable logistic regression analysiswas used to identify factor associated with dependent variable. P value < 0.05 wasconsidered as statistically significant at 95% CI. Results:The prevalence of prevention of mother to child HIV transmission service utilization among pregnant women was 91.2% with 95% CI: 88.6, 93.5%.Urban residence,womenwho attended formal educationand women whose husband had tested forHIVwere factors significantly associated with PMTCT service utilization. Conclusion:The utilization of Human immune virus counseling and testing as prevention of mother to child HIV transmission service in this study was lower when compared to the national recommendation set forth in the national guideline.. Respondent’s residence, women educational status and partner counseling and testing were associated with PMTCT service utilization.Strengthening male involvement in the prevention of mother to child HIV transmission service was essential. Key Words: PMTCT Service utilization, South Gondar Zone.