BACKGROUND Intrapartum hypoxia potentially sets a fetus on a pathway of asphyxia, acidosis, neuronal injury, death or long-term morbidity. The goal of every obstetrician is to have a healthy baby at the end of every pregnancy with minimal risk to the mother and baby. High-risk pregnancies possess a great challenge with high incidence of perinatal morbidity, mortality and litigations; hence the need to identify fetuses at risk as soon as they are born. Traditionally, the Apgar score has been used over the years as a useful tool for rapid assessment of neonatal outcome at birth; however, its use has remained limited as a result of its subjective nature. Umbilical cord pH and Lactate has been suggested in some literatures as a more objective measure of neonatal outcome, as it reflects the past, present and future of the baby. However, studies have been limited with conflicting reports in this regard. AIMS/OBJECTIVES This study aimed to evaluate Umbilical Cord pH, Lactate and Apgar score as predictors of perinatal outcome in high and low risk pregnancies. SUBJECTS AND METHOD This was a cross sectional study that involved 200 mother-fetal pairs who presented with labour pains. Having met the inclusion criteria, they were classified into high and low risk if they had any perinatal risk based on their perinatal risk factors after obtaining a written informed consent for participation in the study. Within a minute after delivery, umbilical cord was clamped on both ends and arterial blood samples were collected in a heparinized syringe. The pH was measured using the pH analyzer/meter and the lactate was measured using the lactate pro 2 meter. The analysis was done within 30minutes after sampling. Trained research assistants pediatricians or resident doctors in obstetrics and gynecology department) assigned APGAR scores at first and fifth minute of life to the neonate. Patient’s information was obtained using a structured questionnaire. Data analysis was done using statistical package for social sciences (SPSS) software version 21.0 (SPSS Inc, Chicago, USA) with p-value  0.05 taken to be statistically significant, Chi-square, correlation coefficient and receiver operator characteristics (ROC) curve analysis were used.