India accounts for a fifth of annual global maternal deaths. The referral system is an essential component of any health systems which is particularly important in pregnancy and childbirth for providing access to essential obstetric care. The 3-tier health care delivery system was conceived in such a manner that the patients in need of a higher level of expertise and care could be referred accordingly from primary to secondary directly to tertiary level centre. Hence the present study was aimed to study the maternal and perinatal outcomes among referred obstetric cases