Aim: To observe the spectrum of obstetric patients and fetomaternal outcome in a tertiary care centre in Bihar, India. Materials and methods: A prospective study was conducted in the Department of Obstetrics and Gynaecology, Patna Medical College and Hospital, Patna, Bihar, India, from January 2016 to January 2017.unbooked patients who where referred from different districts of bihartheir clinical profile, clinical course, mode of delivery, both maternal and perinatal outcomes were documented. Results: A total of 120 cases were referred to this higher centre due to various reasons. Maximum number of cases in present study were in the age group of 20-30 years comprising 76(63.33%) of total cases. Majority of the referral cases were primigravida 61 (50.83%). Out of 120 referred cases, 100(83.33%) delivered, 12 (10%) were treated conservatively. In 8 patients (6.67%) either abortion occurred or medical termination of pregnancy was done or there was ectopic pregnancy or perineal tear who were managed accordingly. Out of the 100 cases who delivered at our institute majority of the babies 68(68%) delivered normally, while 32 (32%) underwent caesarean section. Out of 100 deliveries, there were 24 NICU admissions and 76 were healthy babies. Reasons for admission were varied. In the present study, hypertensive disorder of pregnancy was the most common cause of referral (17.5%). Conclusion: Childbirth is a normal physiologic process, but emergencies can arise anytime. The present study has shown that improper antenatal and intranatal care at the primary healthcare level is responsible for poor maternal and perinatal outcome. Hypertensive disorders of pregnancy have been one of the commonest causes of referral among high risk obstetric patients which could be managed at the primary healthcare centre through regular ANCs and timely intervention.