Background: Preterm labor is a major determinant of neonatal mortality and morbidity worldwide, especially in developing countries. Aims: The study aimed at finding out the incidence and the etiological risk factors responsible for preterm labor that could be targeted to reduce its risk. Materials and methods: In this prospective cohort study of 1 year, a total of 440 antenatal patients diagnosed with preterm labor were included and were followed up. In addition to the known risk factors for preterm labor, investigation data, gestational ages, neonatal outcome, and response to tocolysis if given were noted. The collected data were analyzed using descriptive statistics. Results: The incidence of preterm birth for the current study was 6.7%. The majority of patients were multigravida (59%) and mainly were of the age lesser than 30 years (89.3%). A total of 477 babies including 37 twins were delivered by 440 preterm deliveries of which 377 (79.03%) were live births. About 40.90% of babies had a birth weight in the range of 1.6–2 kg. Neonatal morbidity in preterm babies was 49.33% and was high with patients who had not received steroid coverage (90%) and when the gestational age was less than 34 weeks (72.57%). Similarly, neonatal mortality was found to be 26.52% in preterm babies and was higher in patients who did not receive steroid coverage (63.4%) and also when gestational age was less than 34 weeks (44.18%). Conclusions: Early recognition, appropriate management, and early administration of steroid in high-risk pregnancies along with advice on modifiable etiologies and preconception counseling can bring down preterm birth and thereby reduce neonatal morbidity and mortality.