Introduction: Antenatal fetal surveillance is essential for improving outcomes in highrisk pregnancies. The Non-Stress Test (NST) plays a critical role in assessing fetal well-being by evaluating heart rate responses to fetal movements. Aim and Objectives: The aim of this study is to evaluate the effectiveness of NST in predicting outcomes in pregnancies beyond 32 weeks. The objectives include assessing the correlation between NST findings and maternal outcomes, evaluating its association with fetal outcomes.Materials and Methodology: This prospective observational study was conducted in the labor room of the Department of Obstetrics and Gynaecology at GMC Akola over 18 months. It included 107 pregnant women beyond 32 weeks of gestation. Data collection involved medical history, obstetric examination, and NST results. Outcomes such as delivery mode, birth weight, APGAR scores, NICU admissions, and hospital stay were recorded. Statistical analysis was performed using descriptive statistics and chi-square tests.Result: The study found 84(79%) of NSTs were reactive, indicating healthy fetal heart rates, while 23(21%) were nonreactive. Reactive NST cases showed better neonatal outcomes, including higher Apgar scores, lower rates of NICU admissions, and higher survival rates compared to nonreactive cases. Nonreactive NSTs were associated with increased risks of meconium-stained liquor, oligohydramnios, intrauterine growth restriction (IUGR), and fetal distress.Conclusion: NST serves as an important indicator for identifying high-risk pregnancies and guiding clinical decisions. In resource-limited settings, nonreactive NSTs can aid in monitoring and referral decisions. Overall, NST is essential for assessing fetal well-being and can help reduce perinatal morbidity and mortality.