Although pregnancy is a physiological process, it is not hassle free.Any normal pregnancy can turn anytime into a life threatening event despite all cares being taken. Maternal Mortality is still very high in many of the low resource countries compared to the developed countries. Available DATA suggests that in many countries MMR is still very high and not lowering even within a reasonably organized health care set up. In Nepal, Safe Motherhood Program was started during 1997 and some significant progress was made in health care infrastructure. But the millennium development goal (MDG 5) of 213 maternal deaths per 100,000 live births by 2015 is yet to be achieved. Present hospital based study was an attempt to identify antenatal cases with risk factors by using pre validated simple score card, to observe risk status of mothers during prenatal period and intrapartum period , link pattern of risk factors to have a base line data in Nepal. The study comprised of 2466 antenatal cases. out of them 726 were in high risk and 1740 at low risk group. both the groups received adequate antenatal care in the ANC clinic of Manipal Teaching Hospital. More risk factors were present in high risk group than low, bad obstetric history, mild anemia and poor weight gain during pregnancy were the common risk factors present. In the low risk group average risk factors per woman was 1.17 while the average was 2.56 in the high risk category. Out of 726( 29.44%) cases who were initially at high risk,529(70.91%) remained at high risk during intrapartum period whereas the remaining 197 (26.41%)were converted to low risk. Out of 1740(70.56%) initial low risk cases, 346(19.88%) developed complications later on thus subsequent risk status of 1923 (77.98%) was low and 543 (22.02%) high respectively. Prolonged labour (2.34%), Premature rupture of membrane (44.63%) and traumatic deliveries (1.52%) were more in high risk group. Interventions like induction of labour and artificial rupture of membrane were higher in high risk group. The study suggests that it is possible to identify at risk expectant mothers with a simple risk scoring system during antenatal period. Intervention in time can reduce the risk and will have an impact in reduction of maternal mortality rate.