Background: Grand multipara concerning obstetric performance is labeled as a high-risk pregnancy. It continues to challenge obstetric practice in the developing world. The overall incidence is between 10 and 30% with a higher incidence in the developing countries. Objective: This study aimed to determine maternal and perinatal outcomes in a grand multipara at a tertiary care center. Materials and methods: A prospective observational study was conducted for 2 years. All grand multipara women admitted for labor and delivery were enrolled in the study after meeting the inclusion criteria and were followed till discharge for any complications if present. The collected data was entered into an Excel sheet and analyzed for the results. Results: The majority of the participants (81%) were aged 26–35 years and belonged to lower-middle socioeconomic status (60%). Common complications included anemia (73%), hypertensive disorders (11%), and postpartum hemorrhage (19%). Vaginal delivery was achieved in 77.5% of cases, while 20.5% underwent cesarean section. The most common indication for cesarean section was cephalopelvic disproportion (27.5%). Perinatal outcomes showed that 11.5% of newborns had low-birth-weight, and neonatal intensive care unit (NICU) admission was required in 26.5% of cases. Conclusion: Grand multipara pregnancies continue to present challenges due to their higher risk of maternal and perinatal complications. Early and frequent prenatal care, health education, and access to emergency obstetric services are crucial in mitigating these risks.