Objective The study aimed at assessing trans-placental transmission of Chlamydia trachomatis (CT) and fetal survival at birth among CT infected mothers. Study Design This is a non-interventional prospective cohort study. Population /Study Setting The study was conducted among two thousand and fourteen pregnant women attending antenatal clinic at the Cape Coast Teaching Hospital. Methodology Cord blood from neonates born to one hundred and twelve (112) pregnant women whose cervical samples were positive for CT at first ANC visit were screened by Polymerase Chain Reaction (PCR) for CT infection. Transplacental transmission of CT was considered when CT DNA type-specific agreement was observed between the samples of maternal cervical specimen and the corresponding neonatal cord blood. A neonate who did not survive at birth at > 28weeks gestation or 1000g birthweight is considered stillbirth. Results There were one hundred and one (101) live births and eleven (11) stillbirths. Of the 101 live births, two (2) of the cord bloods were CT DNA positive whereas nine (9) of the eleven (11) stillbirths were cord blood positive for CT DNA. The two (2) neonates with cord blood positive for CT DNA developed early onset neonatal sepsis. There is therefore, a strong evidence that trans-placental CT infection is associated with stillbirth P< 0.001; OR, 38.5 ; 95% CI (6.91 – 412.3). Conclusion Antibiotic prophylaxis for pregnant women at risk for CT infection is recommended. Routine screening for all pregnant women should be considered for prenatal care in medium to long term planning.