Introduction: Although maternal mortality remains a public health issue, maternal death in actual number is less in community. As maternal death in itself is not sufficient to assess the level of health care concept of Near miss is introduced by WHO, though yet not widely adapted in reviews across our nation and being overcome by wide variety of high risk pregnancies. Objective: To determine frequency and nature of near miss events among pregnant women. 2. To compare nature of near miss pregnancies with high risk pregnancies. Methodology: A Case Control study of cases of near miss and high risk pregnancies which occurred over one year duration between 1st July 2018 to 30th June 2019 at Atal Bihari Vajpayee Govt. Medical College, Vidisha (M.P.). Near Miss definition was based on validated disease specific criteria comprising of diagnostic categories: haemorrhage, hypertensive disorder of pregnancy, anemia, sepsis, hepatic encephalopathy and other indirect causes. Near miss cases were determined for various disease processes and compared with high risk cases to assess the need for change in approaching these pregnancies. Result: There were 5993 deliveries and 7 maternal deaths. Significant difference was observed in characteristics of near miss and high risk pregnancies. Conclusion: Our review shows that beside the women who died due to pregnancy related complication, there were many additional women who received critical care during the same period and survived. Hospitals in India could benefit by including near miss investigations in their approach to all high risk pregnancies.