Background: Genuine preterm labor precedes almost half of preterm births and preterm birth is the leading cause of high prematurity and neonatal mortality indices in the world. In Nigeria, there is a paucity of recent data on the pattern of preterm labor and preterm births, including its prevalence and neonatal outcome. Objective: To determine the prevalence, patterns and immediate neonatal outcomes of preterm labor and preterm births in a single center population. Methods: This was a retrospective cross-sectional analytical study of all pregnant women who had preterm labor and/or preterm births at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria from January 1, 2014 to December 31, 2015. Women who delivered outside the study hospital were excluded. Data was manually collected from the patients’ case files using a proforma and analyzed using a Statistical Package for Social Sciences (SPSS) version 20. P < 0.05 was considered statistically significant. Results: A total of 1573 deliveries were recorded of which 139 had preterm births, giving a prevalence of 8.8%. Thirty-five women had spontaneous, genuine preterm labor, giving a prevalence of 2.2%. The mean age of the women was 30.2 ± 2.3 years. Forty seven (33.8%) women were nulliparous, while 12 (8.6%) were grand multiparous. Majority, 103 (74.1%) were unbooked. Sixty five (46.8%) of the preterm births were iatrogenic while 35 (25.2%) were due to spontaneous preterm labor. Of the 139 women, 81 (58.3%) delivered via cesarean section and 125 (89.9%) had singleton births. Fifty four (38.8%) of the preterm babies had a birth weight of 1500-2499 grams, while the 14 (10.1%) had a birth-weight in <1000 grams. Seventy seven (55.4%) of the babies were males. One hundred and four (74.8%) babies were non-asphyxiated, 18.0% had a stillbirth, although 12 (8.6%) had immediate neonatal deaths while 102 (73.4%) were live births. Ninety one (65.5%) preterm babies did not require immediate resuscitation while 87 (62.6%) babies required admission into the Special Care Baby Unit. Sixty three (45.3%) preterm babies were moderate to late preterm (32 to <37 weeks), 58 (41.7%) were very preterm babies (28 to <32 weeks) and 18 (12.9%) were extremely preterm babies. There was statistical significance, association between the gestational age at birth and some neonatal outcomes such as birth weight (p-value=<0.001), Apgar scores (p-value=0.002), and the need for immediate neonatal resuscitation (p-value=0.010) Conclusion: The prevalence of preterm birth and spontaneous, genuine preterm labor was high in Nnewi, Nigeria and iatrogenic preterm births predominate. There were significance association between gestational age at preterm birth and route of delivery, birth weight, Apgar scores, and need for immediate neonatal resuscitation. Women and neonates at greater risk of preterm births need optimal care to improve survival.