evidence: High-risk pregnancies contribute 70- 80% of maternal morbidity and mortality. Treating high-risk pregnancies with adequate care will give a significant reduction in maternal mortality and morbidity. In Tamil Nadu, the proportion of high-risk pregnancies among antenatal mothers is 10-30%. Tamil Nadu issued guidelines for early detection and management of high-risk pregnancy and set to achieve a maternal mortality ratio less than 45/100,000 live births by 2017 [4]. Despite measures, the High-risk pregnancy percentage of the Tiruchirappalli health unit district was static. Hence, we envisaged evaluating the status of implementing high-risk pregnancy guidelines in the Tiruchirappalli health unit district of Tamil Nadu, India. [...] The following high-risk pregnancies were identified during the study period (Table 1), anemia in 1278 (13%), Pregnancy-induced hypertension (PIH) in 28 (0.3%), Gestational diabetes mellitus (GDM) in 15 (0.3%), and Foetal anomalies identified in 3 (0.06%). Of the 1278 mothers with anemia complicating pregnancy, 628 (49%) were started on parenteral Iron sucrose therapy, 19 (5%) started on blood transfusion, and 44 (3%) were referred to higher centers. None of the GDM mothers was treated at PHCs, and 12 (80%) were referred to higher centers. 22 (78%) pregnant women with PIH were started on therapy with labetalol at PHCs, and 12 (43%) of them were referred to higher centers.