Background: Cesarean section (CS) is a potentially life-saving procedure but also poses serious risks, particularly hemorrhage necessitating blood transfusion. Predictive factors for transfusion in primary CS are an important way to improve maternal morbidity and mortality, particularly in resource-limited settings. Objective: The objective of this research was to identify prevalence of, predictors and factors for intrapartum and immediate postpartum blood transfusion in ladies who undergo primary CS at Omdurman Maternity Teaching Hospital. Methods: We carried out a prospective cross-sectional study in a hospital setting involving 1,196 primary CS patients for 12 months. Medical data were obtained and analyzed using SPSS v25. Results: The relationships of maternal, obstetric, and neonatal covariates with transfusion outcome were examined using univariate and multivariate logistic regression.Results: Among 1,196 patients, 97 (8.1%) required blood transfusion. Prolonged 1st stage of labor (OR = 1.60, p = 0.035), pre-eclampsia/eclampsia (OR = 2.05, p = 0.007), hemorrhage (OR = 3.00, p < 0.001) were predictors. Transfusion rates in patients with placental abruption, placenta previa, and maternal age ≥35 years were high. Transfusion risk had been augmented because of nulliparity and low educational level.