Background <p>Preoperative anxiety is a prevalent health issue that, if left unaddressed, may contribute to an elevated risk of perioperative complications. Limited data exist on this concern in Africa, with no studies conducted in Sudan. This research aims to evaluate the prevalence and associated factors of preoperative anxiety in Sudanese women scheduled for elective cesarean delivery.</p> Methods <p>A cross-sectional study was conducted among women scheduled for elective cesarean delivery at Gadarif Maternity Hospital. A questionnaire was used to collect sociodemographic and clinical data. The “State-Trait Anxiety Inventory—State” (STAI-S) subscale was used to assess preoperative anxiety.</p> Results <p>A total of 234 women participated in this study. The median (interquartile) of their age and parity was 28.0 (24.0–32.0) years and 3 (1–5), respectively. The mean anxiety score on the STAI-S was 41.24, and 96 (41%) of the women exhibited significant anxiety (STAI-S score of 44 or higher). Univariate regression analysis revealed that none of the investigated factors (age, parity, number of antenatal care visits, body mass index, educational level, residence, occupation, history of infertility, history of stillbirth, history of cesarean delivery, history of surgery other than cesarean delivery, family history of surgical complications, and history of blood transfusion) were associated with preoperative anxiety.</p> Conclusion <p>This study revealed that 41.0% of women scheduled for elective cesarean delivery experienced significant preoperative anxiety. Interestingly, this anxiety was not found to be associated with any of the factors previously reported to be linked with preoperative anxiety in other countries.</p>