Background: Timely and prompt referral of high risk pregnancies is an integral part of emergency obstetric care and is one of the effective strategies to avoid adverse pregnancy outcomes. This study aims to assess the maternal determinants and characteristics of obstetric referrals to Travancore Medical College and Hospital.Methods: This observational study reviewed 124 obstetric referrals over 3 years. Maternal risk factors and sources of referral were looked into. Distance travelled, referral-arrival interval, mode of transport, gestational age at referral, medical co-morbidities necessitating emergency/elective transfers to this tertiary centre have been analysed.Results: Referral rate was 7.03%. Mean age was 26. Primipara and multipara went hand in hand. 95% were graduates. Materno-fetal (58%) contributed the bulk of obstetric referrals. 83.1% were from private hospitals and 64 were in-labour referrals. 71.6% had referral arrival distance of <15 kms. Mode of transport used by the referred patients was by ambulances (73.9%). Around 48% of our population had GA of 33-36.6 weeks. 73% had emergency decision among which caesarean was 83%. Anaemia (34%), HDP (30.5%), GDM (14.2%) and hypothyroidism (17.7%) were medical co-morbidities necessitating referrals. There was 1 maternal death and 4 near miss mortality cases. Mean hospital stay in private sector referrals was 10.17 days and it was 7.62 days in government referrals.Conclusions: Timely referrals with detailed referral slips imparting information regarding treatment received at the referring hospital has helped in early and optimal intervention in the study.