Background: Preterm birth, defined as delivery before 37 completed weeks of gestation, remains one of the leading causes of neonatal morbidity and mortality worldwide. Multiple maternal, fetal, obstetric, and socioeconomic factors contribute to preterm delivery. Early identification of high-risk pregnancies enables timely interventions to improve maternal and neonatal outcomes.Objective: To evaluate the risk factors associated with preterm birth among pregnant women attending a tertiary care hospital.Methods: A retrospective observational study was conducted among 350 pregnant women who delivered at a tertiary care hospital between January and December 2025. Women were categorized into preterm (<37 weeks) and term (≥37 weeks) delivery groups. Demographic characteristics, obstetric history, maternal comorbidities, antenatal complications, and neonatal outcomes were analyzed. Multivariate logistic regression identified independent predictors of preterm birth.Results: Among the 350 deliveries, 72 (20.6%) resulted in preterm birth. Maternal anemia (41.7%), pregnancy-induced hypertension (30.6%), urinary tract infection (26.4%), previous preterm birth (23.6%), multiple pregnancy (15.3%), and inadequate antenatal care (36.1%) were significantly associated with preterm delivery (p<0.05). Independent predictors included previous preterm birth, pregnancy-induced hypertension, maternal anemia, multiple gestation, and cervical insufficiency.Conclusion: Preterm birth is strongly associated with preventable maternal and obstetric risk factors. Early antenatal screening, adequate prenatal care, nutritional support, infection control, and management of high-risk pregnancies are essential to reduce the incidence of preterm birth.