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Context: Preterm birth is defined as births before 37 weeks of gestational age. Preterm birth is a major challenge in obstetric health care and leading cause of perinatal mortality and long-term morbidity. Complications arising from preterm births are the leading cause of deaths among children less than 5 years of age. Seventy-five percent of them could be saved with current, cost-effective interventions. The rate of preterm births worldwide is 5-18% with the developing countries accounting for the maximum deaths. Aims: This study was undertaken to evaluate the prevalence of preterm births and risk factors associated with it among women delivered at a rural tertiary teaching hospital in Telangana and further assess its impact on perinatal outcome. Settings and design: This was a retrospective case control study conducted at Mediciti Institute of Medical Sciences from January 2019 to December 2019. Methods and material: Of the 1243 deliveries during the study period, 135 births that occurred at <37 weeks were taken as cases and 248 term neonates were taken as control group. Data were collected retrospectively through review of prenatal and hospital delivery records. Statistical analysis used: Data were collected and tabulated as shown in the results. Statistical analysis was done using Microsoft Excel. Frequency and percentage of each parameter were calculated and analyzed. The risk estimates were analyzed between the cases and controls by calculating the odds ratio, 95% confidence interval, and P value. P Value of <0.05 was considered significant. Results: The prevalence rate of preterm birth was 10.86%. History of previous preterm birth (OR = 4.88, C.I: 1.50-15.87, P = 0.0084), previous LSCS (OR = 2.16, C.I: 1.36-3.44, P = 0.001), inter-pregnancy interval <12 months (OR = 2.78, C.I: 1.13-6.84, P = 0.026), hypertension (OR = 3.10, C.I: 1.78-5.42, P = 0.0001), PROM (OR =0.73, C.I: 2.36-9.49, P < 0.0001), Oligohydramnios (OR = 3.58, C.I: 1.29-9.9, P = 0.01), and multiple pregnancy (OR = 24.09, C.I: 3.09-187.46, P = 0.0024) were found to be significant risk factors for preterm birth. Though the NICU admission rate was high (52%), neonatal outcome was found to be satisfactory. Conclusions: Some of the risk factors that contributed to preterm birth were modifiable. Preventive strategies addressing the risk factors such as hypertension, oligohydramnios, and also improving health care quality to pregnant women will reduce the prevalence of preterm births and outcomes. [ABSTRACT FROM AUTHOR]