Background: Pregnancy and child birth particularly in high risk patients need proper antenatal care and timely referral to decrease maternal and perinatal morbidity and mortality. Early identification, initiation of early treatment and timely referral are the components for success of maternal and fetal health intervention. To identify the pattern of obstetric referral and primary reasons of referral, so as to implement measures to reduce maternal and perinatal morbidity and mortality. Aim of study: To assess Maternal and Perinatal outcome in referred patients. Materials and methods: Prospective observational study done in all obstetric patients referredto the department of OBG at Sri Siddhartha Medical Hospital, Tumakuru for duration of 24 months. Results: The proportion of referral cases to the tertiary care institute is 6.5%. Majority (48.7%) of referred cases were from private hospitals and PHC (44%) showing lacunae in the emergency obstetric care given. Majority were in the age group 21-30 constituting about 72%. In present study, there was unavailability of ambulance in 56.7% of cases for transport. Most (92.89%) of the patients were not accompanied by any medical assistance during transport. Most common cause of referral is previous LSCS (28.7%) followed by PROM (16%). In our study, 10 % of the patients required blood/blood products transfusion. Majority delivered by LSCS (92.7%).There were 1 (0.7%) maternal mortality in present study & behind these there were total 12(8%) near miss cases which provide valuable information on the quality of antenatal care at the periphery. 42.9% of all neonates had respiratory distress in this study. Total NICU admission rate was 42.7%. Neonatal mortality documented in present study was 0.7%. Conclusion: Proper training of health personnel at peripheral centres and timely referral along with detailed referral slip or prior information of high risk cases helps in early and effective interventions thereby decreasing maternal and perinatal morbidity and mortality. Health education and awareness by mass media and non-government organisations can improve the health and social status of women in rural areas.