Objective: Early detection and effective management of high-risk pregnancies can substantially contribute to the reduction of adverse maternal and fetal outcomes. This study aimed to determine the prevalence and clinical profile of women with high-risk pregnancies in rural areas who utilize antenatal services in a primary health center (PHC).Materials and Methods: A retrospective analysis was carried out over a six-month period by reviewing the mother and child protection cards maintained at the PHC’s Maternal and Child Health Center. During the study period, 950 pregnant women were registered, of whom 793 were included in the study based on the completeness of the records. Data analysis was performed using the licensed Statistical Package for the Social Sciences (SPSS) software version 21.0.Results: The prevalence of high-risk pregnancy among the antenatal women was 272 (34.3%) with 95% CI [31.1–37.7]. Of the 272 women, 240 (88.2%) had a single high-risk factor, while 32 (11.8%) had more than one high-risk factor. The major factor contributing to high-risk pregnancy was hypothyroidism (43.7% with 95% CI [37.9–49.6]), followed by a previous lower segment Caesarean section (LSCS) (19.1%).Conclusion: The study found that the prevalence of high-risk pregnancies was 34.3% in this rural setting. The majority of high-risk pregnancies were due to hypothyroidism, followed by more than one previous LSCS or abortion. Further research is required to track high-risk pregnancy outcomes and investigate the newborn thyroid profile of women with hypothyroidism.