Background: Prolonged labour remains a significant contributor to maternal and perinatal morbidity and mortality in Bangladesh. Delayed recognition and referral often lead to adverse outcomes. This study was undertaken to analyze the etiological factors of prolonged labour and evaluate its maternal and fetal outcomes. Methods: This descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynecology, Sir Salimullah Medical College & Mitford Hospital, Dhaka, from June to December 2009. A total of 110 purposively selected pregnant women with prolonged labour (labour pain >18 hours) were enrolled. Data were collected through interviews, clinical examination, and record review. Results: The majority of patients were primigravida (62.7%) and aged 21–30 years (57.27%). Most had no ANC (60%) and belonged to low socioeconomic backgrounds (69.09%). Uterine hypotonicity was the leading cause (45%), followed by malposition (22.72%). Caesarean section was required in 60.50% of cases. Maternal complications occurred in 65%, with PPH (20%) and puerperal sepsis (14.54%) being most common. Perinatal complications included asphyxia (13.63%), umbilical sepsis (10%), and stillbirth (6.36%). Barriers to early hospital admission included reliance on midwives (31%), TBAs (18.18%), and poor economic conditions (20%). Conclusion: Prolonged labour is associated with substantial maternal and perinatal morbidity. Strengthening ANC, improving referral systems, training birth attendants, and ensuring timely access to emergency obstetric care are essential to improve outcomes.