Abstract Background:Globally, antepartum hemorrhage is a major cause of maternal and perinatal morbidity and mortality during pregnancy and childbirth. The condition leads to severe maternal complications such as hemorrhagic shock, anemia, blood transfusion, and operative delivery, as well as poor perinatal outcomes, including preterm birth, stillbirth, and early neonatal death. Despite improvements in antenatal care and emergency obstetric services, poormaternal and perinatal outcomes related to antepartum hemorrhage persist in resource-limited settings. Objective: To determine maternal and perinatal outcomes of antepartum hemorrhage and identify associated factors for adverse outcomes among women diagnosed with APH in Bahir Dar’s public hospitals. Methods: A hospital-based cross-sectional study was conducted from September 1, 2024, to August 30, 2025, at FelegeHiwot and TibebeGhion Comprehensive Specialized Hospitals. The study included 341 women diagnosed with antepartum hemorrhage, selected through systematic random sampling. Data were collected using a structured checklist developed in Kobo Toolbox and exported to Microsoft Excel for cleaning and imported to SPSS version 27 for coding and analysis. Descriptive and analytical statistics, bivariate, and multivariable logistic regression were conducted to identify perinatal and maternal outcomes and associated factors. Results Maternaloutcomes occurred in 19% of women. The most frequent complications were anemia (16.1%), postpartum hemorrhage (13.8%), and peripartum hysterectomy (4.1%). Adverse perinatal outcomes were observed in 38.6% of cases, including preterm birth (44%), low birth weight (38.4%), NICU admission (28.4%), stillbirth (7.2%), and intrauterine fetal death (5%). Independent predictors of outcomes were rural residence (AOR=2.58, 95% CI: 1.81–8.29), absence of antenatal care follow-up (AOR=3.12, 95% CI: 2.69–4.83), and bleeding ≥12 hours (AOR=2.50, 95% CI: 2.34–4.05). Perinatal outcomes were associated with rural residence (AOR=1.26, 95% CI: 1.14–2.88), lack of antenatal care follow-up (AOR=03.13, 95% CI: 1.08–3.35), preterm delivery (AOR=2.07, 95% CI: 1.58-3.63), and placental abruption (AOR=1.27, 95% CI: 1.22-3.52). Conclusion: APH remains an important contributor to maternal and perinatal morbidity. Strengthening antenatal care, ensuring timely referral and emergency transport, and improving early management of obstetric bleeding are vital to improving outcomes among mothers and newborns.