Background: Adverse births outcomes are the leading causes of neonatal mortality at worldwide. Ethiopia is one of the countries struggling to reduce neonatal mortality in different strategies but, still the neonatal mortality is remaining high due to many reasons. Despite adverse birth outcome is public health problem in Ethiopia, the contribution of Premature rupture of membrane for adverse birth outcome is neglected and not well explained in our country. Objective: To assess birth outcomes and associated factors among mothers with PROM at Specialized Hospitals in Amhara Region, Ethiopia, 2022. Methods: Institution based cross sectional study design was applied among 538 mothers with PROM at Amhara region specialized hospitals. We used systematic sampling techniques to select the medical charts diagnosed with Premature rupture of membrane and give birth in the hospital within the period from July 08, 2019, to July 07, 2021. The data were collected by using checklist, entered Epi Data version 3.1 and analyze by SPSS version 23. Binary logistic regression model was used to see the association between independent and dependent variable. P-value <0.05 was used to declare as statistically significant. The AOR with 95% CI was used to measure the strength of association. Result: - Adverse birth outcome among Premature rupture of membrane mothers was 33.1% (95% CI 29.2-37.2). Rural residence [AOR=2.94, 95% CI :1.73-4.97], have history urinary tract infection [AOR=6.87, 95% CI (2.77-17.01)], anemia [AOR=7.51, 95% CI (2.88- 19.62)], previous history of adverse birth outcome [AOR=3.54, 95% CI (1.32-9.47)] and less than two years inter pregnancy interval [AOR=6.07, 95% CI (2.49-14.77)] were directly associated with adverse birth outcome. Conclusion: - The adverse birth outcome was high in Amhara region as compared the world health organization estimated figure and target the target is less than 15%. History of previous adverse birth outcome, rural residency, Urinary tract infection, Anemia and shorter Inter pregnancy interval had association with adverse birth outcome among PROM mothers. Therefore, close follow-up for the mothers who had previous adverse birth outcome, early screening and treatment of urinary tract infection, anemia prevention and maximize birth interval is important to prevent adverse birth outcome. Key words: Adverse Birth Outcome, PROM, Amhara Region