PIP: The study aim was to determine risk factors associated with preterm delivery, perinatal mortality, and neonatal morbidity among 687 indigent, pregnant women in their first term registered with the New Civil Hospital, Ahmedabad, India, between September, 1989, and March, 1991. Women were scored according to their level of risk: no risk, mild risk, moderate risk, and severe risk, from scores based on sociodemographic and obstetric data: pallor, maternal weight, 2 or more prior abortions, first pregnancy or 5 pregnancies, adolescent pregnancy, prior preterm birth, prior prenatal mortality or stillbirths. Out of 696 deliveries, there were 71 (10.2%) preterm births, of which 3 (2.38%) were among women within the no risk groups. There were 47 (11.10%) from the mild risk group and 20 (14.08%) from the moderate risk group. There were 20% from the severe risk group. Perinatal mortality was 84.77/1000 births, and 7.94 among the no risk group. The perinatal mortality rate rose with level of risk, with 92.20 per thousand births for the mild risks to 200 for the severe risks, which was statistically significant. Neonatal morbidity also increased with the increased level of risk. Preterm birth was found not to be associated with pallor and prior history of stillbirth. Perinatal mortality was not associated with pallor and first pregnancy. Factors significantly associated with preterm births and perinatal mortality were maternal malnutrition, higher pregnancy order, older maternal age at delivery, and prior preterm births and fetal loss. Pregnant women with risk factors had greater relative risk of preterm birth and perinatal mortality by 5.01 and 13.09 times. With maternal risk factors, the risk increased by 80.05% and 92.35%. The risk factors were highly sensitive for preterm births (95.77%), but had low specificity (19.69%), and low positive predictive value (11.93%). Perinatal mortality sensitivity, specificity, and positive predictive values were 98.31%, 19.90%, and 10.34%n respectively. The findings differed from previously reported studies; scoring system used has a higher sensitivity to predicting preterm birth and perinatal mortality among high risk women, and poor sensitivity among low risk women. Moderate and mild could be identified with this system and referred for follow-up.