High-risk pregnancy is a major contributor to maternal and neonatal morbidity and mortality worldwide, particularly in low- and middle-income countries where access to quality healthcare remains limited. It encompasses a range of conditions that increase the likelihood of adverse outcomes for the mother, fetus, or both, including pre-existing medical disorders, pregnancy-induced complications, and socioeconomic determinants. Effective management of high-risk pregnancy requires early identification, continuous monitoring, and timely intervention to prevent complications and improve outcomes. Obstetric nurses play a pivotal role in this process as frontline healthcare providers responsible for comprehensive antenatal, intrapartum, and postnatal care. Their responsibilities include risk assessment, patient monitoring, health education, emotional support, and coordination with the multidisciplinary healthcare team. Evidence-based nursing interventions have been shown to significantly reduce complications such as preeclampsia, preterm birth, and neonatal distress. This article reviews literature from the past ten years to examine the concept of high-risk pregnancy, associated complications, and management strategies, with a particular focus on the role of obstetric nurses in improving maternal and fetal outcomes. The findings highlight the importance of strengthening nursing education, enhancing clinical competencies, and promoting patient-centered care approaches. Improving the knowledge and practice of obstetric nurses is essential for reducing maternal and neonatal mortality and ensuring safe pregnancy outcomes.