Background: Fetal movement is an early sign of life and indicates well-being. Reduced fetal movement is common in pregnant women, affecting perinatal outcomes and increasing risks of stillbirth, growth restriction, distress, and preterm birth. The biophysical profile (BPP) assesses fetal well-being in the last trimester. This study evaluated the association between BPP scores, delivery mode, and neonatal outcomes in women with reduced fetal movement at term. Methods: This analytical cross-sectional study was conducted at the Department of Obstetrics and Gynaecology, Dhaka Medical College and Hospital, Bangladesh, from August 2019 to July 2020. One hundred women at ≥37 weeks of gestation with reduced fetal movement were enrolled and divided into normal (≥8/10) and abnormal (≤6/10) BPP groups. Maternal demographics, mode of delivery, and perinatal outcomes were recorded. Data were analyzed using SPSS version 20.0. Results: Caesarean section rates were significantly higher among women with abnormal BPP (80.95%) compared to those with normal scores (46.55%) (p=0.002). Vaginal deliveries predominated in the normal group. Perinatal outcomes were generally favorable, but neonatal death and stillbirth occurred more frequently in the abnormal BPP group (7.14%) compared to the normal group (1.72%), though this difference was not statistically significant. Conclusion: Abnormal BPP scores correlated with higher caesarean rates and adverse outcomes. However, no significant difference in mortality was observed. Findings suggest BPP helps identify at-risk fetuses, but delivery decisions should combine test results and clinical judgment to balance intervention with outcomes.