Aim: This study aims to observe spectrum and outcome of obstetric referral pattern in a tertiary care centre in Bihar, India. Materials and methods: A prospective study was conducted in the Department of Obstetrics & Gynaecology, Government Medical College Bettiah , West Champaran,Bihar, India, for 1 year. Thorough history was taken; complete physical and obstetric examination and relevant investigations were done. Management of the patient, clinical course, mode of delivery, both maternal and perinatal outcomes were documented. Results: Among 110 patients, maximum number of cases were in the age group of 20-30 years comprising 70(63.64%) of total cases. Majority of the referral cases were primigravida 55 (50%). Out of 110 referred cases, 94 (85.45%) delivered, 9 (8.18%) were treated conservatively. Out of the 94 cases who delivered at our institute majority of the babies were delivered 64(68.09%) delivered normally, while 30 (31.91%) underwent caesarean section. Out of 94 deliveries, there were 22 NICU admissions and 72 were healthy babies. Reasons for admission were varied. In the present study, premature rupture of membranes was the most common cause of referral (17.27%). This is followed by pre-eclampsia and related conditions (15.45%), and meconium stained liquor (9.09%). Previous caesarean sections were the cause of referral in 4.54% of cases. In the present study, 7.27% of cases were referred due to non availability of blood and doctors. 65.45%, 22.72%, 11.81% of the cases were referred to our hospital in their intapartum, antepartum and postpartum period respectively.(table.7). In the present study, 99.10% were live births. In the present study 4.51% had birth asphyxia and 23.40% had NICU admissions. 36.36% of the NICU admissions were for preterm care, 18.18% for meconium aspiration syndrome, followed by 13.63% for neonatal jaundice. Conclusion: We concluded that the timely referral is crucial for a satisfactory maternal and fetal outcome. To reduce the number of unnecessary referrals and to reduce burden on tertiary care hospitals, health care workers should be trained in essential and emergency obstetric care which will help in reducing morbidity and mortality.