Background:Cancer cervix is a leading cause of mortality and morbidity in developing countries like India most probably due to lack of proper screening facilities in the rural and suburban areas or due to the lack of awareness amongst the women of developing countries. Cervical cancer is the fourth most common cancer in the world. Developing countries accounted to about 80% of the global burden. Aim: The aim of the study to evaluate the pattern of cervical Pap smear cytology at a tertiary hospital and to correlate it with clinical findings. Material and Methods: The prospective study was carried out at Dept. of Pathology Government Medical College, Bettiah, West Champaran, Bihar, India for one year. The cellular material obtained on the spatula and cytobrush was quickly smeared on a clean glass slide, labelled, fixed in 95% ethyl alcohol immediately and subsequently stained by Pap stain. After staining, slides were mounted with DPX (Dibutylphthalate Polystyrene Xylene), screened and reported by cytopathologist under light microscope. Results: Total 1200 cervico-vaginal smears studied during study period on patients, ranging from 18 to 65 years. Cytological findings broadly classified into unsatisfactory smears, normal and abnormal smears. There were 910(75.83%) abnormal Pap smears (benign cellular changes of inflammation as well as Epithelial Cell Abnormalities (ECA), with 265(22.08) normal cases and 25 (2.08%) unsatisfactory or inadequate samples. The age range of patients with epithelial cell abnormality was 22 to 65 years and the mean age was 44.1±12.7 years. They represented 2.5% of abnormal Pap smears and 1.67% of total smears taken. Total 623 (51.92%) showed inflammatory lesion, 14 (1.17%) showed atrophy, 10 (0.83%) showed ASCUS, 6 (0.5%) showed ASC-H, 6 (0.5%) showed HSIL, 2 (0.17%) showed SCC, 3 (0.25%) AGUS, 193 (16.08%) showed metaplasia, 2 (0.17%) had radiation changes. Conclusion: Proper implementation of Pap screening programme, incidence of invasive cervical malignancy can be prevented due to early detection of cervical premalignant lesions.