Intrauterine fetal death (IUFD) remains a public health concern worldwide, particularly in low- and middle-income countries. Adolescents constitute a vulnerable population because pregnancy during this period is frequently associated with biological immaturity, limited reproductive health knowledge, and suboptimal use of antenatal care services. This study aimed to identify factors associated with IUFD and maternal outcomes among adolescents managed in referral hospitals in Yaoundé, Cameroon. A case–control study was conducted in three tertiary hospitals between January 2021 and December 2023. Cases were adolescents admitted with IUFD at ≥22 weeks of gestation or birth weight ≥500 g, while controls were adolescents who delivered live fetuses. Cases and controls were matched in a 1:2 ratio. Data were analyzed using SPSS version 23.0 with univariate analysis followed by multivariate logistic regression. A total of 180 adolescents were included (60 cases and 120 controls). Sociodemographic characteristics did not differ significantly between groups. IUFD cases occurred more at earlier gestational ages and were strongly associated with low birth weight (<2500 g) and placental anomalies. A history of induced abortion, maternal pathology during pregnancy and threatened preterm delivery were significantly associated with IUFD. Multivariate analysis identified maternal pathology, fetal anomaly, and low birth weight as independent factors associated with outcome. Vaginal delivery was predominant. Maternal complications included endometritis, postpartum hemorrhage, disseminated intravascular coagulation, acute psychosis, and maternal death. Strengthening antenatal surveillance and early management of maternal and fetal complications among adolescents may help reduce IUFD in this setting.