Introduction: The world’s second most populous country–India, witnesses 20-30% pregnancies that belong to the high-risk category out of the total pregnancies in the country. 12% of the global maternal deaths are attributed to India. The Rural areas of the country are further vulnerable to high maternal and infant mortality rates due to a rural-urban divide and unavailability of health resources. Objectives: The rationale of this paper is to understand and illustrate common High Risk Pregnancies (HRPs) in the rural area of Shorapur and to gauge the preparedness of the health facility in the area to help deliver safe child birth for the mother and the child. Materials and Methods: A cross-sectional study was conducted in pregnant women attending the Antenatal Care (ANC) clinic in sub-district hospital of northern Karnataka over a period of 03 months. Results: A total of 601 high risk conditions were identified in ANC women. Of the total ANC women with HRP 44.1% (n= 265) had previous Caesarean Section, 15.1% (n=91) had RH incompatibility, 12.6% (n=76) were observed to be Short Primi, 9.7% (n= 58) experienced Bad Obstetric History/Antepartum Haemorrhage, 8.2%% (n=49) had Gestational Hypertension, 5.8%% (n=35), were severely Anaemic, 4.2% (n= 25) had Multiple pregnancy and the remaining 0.3% (n=3) had tumour, Gestational DM and Rheumatoid Arthritis. Discussion: As per the observed HRPs and respective health facility preparedness, two main barriers to safe pregnancy and childbirth emanated during the study - inadequate infrastructure and services for blood transfusion, dearth of trained health professionals. Conclusion: Direct referral of high risk cases to appropriate facilities that have the required capacity to support such cases must be made. Tele-medicine can be considered as an efficient alternative to connect the ANC women with the specialist doctor remotely for evaluation of HRPs. A blood storage unit must be established in all SDH hospitals as a minimum requirement.