Abstract: Despite achievements in antenatal health care, the incidence of maternal mortality and morbidity remains high in India. Lack of efficient obstetric services at primary level lead to more referrals. This study addresses scenario of obstetric care in women referred to a Rural Medical College Hospital located in Central India. This was a prospective observational study conducted in a tertiary care Institute in Ujjain, Madhya Pradesh over a period of 1 year from July 2016 to June 2017. Various parameters studied include distance of referral center, time from referral decision to hospital admission, causes for referral, mode of delivery; and maternal and perinatal outcome. Total number of referred cases in study period was 100 which were 6.68% of total deliveries in the hospital. Fifty percent cases were referred from the city District hospital and travelled less than 10 kilometers reaching within 6 hours of referral. Most common cause of referral was preeclampsia (16%) followed by previous cesarean delivery and fetal distress (13%). Fifty two underwent emergency cesarean delivery, 43 had a vaginal delivery and 4 cases were managed conservatively. Perinatal mortality was 13 and 24 required NICU admission. Inspite of financial aids provided by Government of India majority of referrals were from city District hospital indicating lack of efficient operative facilities and emergency obstetric care. Strengthening of infrastructure, qualified medical and paramedical staff of Civil Hospital may help in improving maternal care. Triage at primary centers might help in lessening burden on tertiary centers and also facilitate specific referral.