Background: Oligohydramnios is a clinically significant obstetric condition associated with increased intrapartum intervention and adverse perinatal outcomes. Reduced amniotic fluid volume compromises fetal well-being by increasing the risk of umbilical cord compression and uteroplacental insufficiency, thereby influencing delivery decisions and neonatal outcomes. This study aimed to evaluate the mode of delivery and fetomaternal outcomes in pregnancies complicated by oligohydramnios. Methods: A hospital-based cross-sectional observational study was conducted in the Department of Obstetrics and Gynaecology, Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh, from December 2009 to June 2010. A total of 50 pregnant women with sonographically confirmed oligohydramnios were included in this study. Cardiotocography was performed upon admission to assess the fetal status. The mode of delivery, indications for caesarean section and neonatal outcomes were recorded. Associations between oligohydramnios severity and outcomes were analyzed. Results: Non-reassuring cardiotocography patterns were observed in 64% of the cases. Caesarean section was the predominant mode of delivery (72%), with fetal distress being the leading indication (61.1%). All women with severe oligohydramnios required caesarean delivery, demonstrating a significant association between severity and delivery mode (p < 0.001). Neonates born to mothers with severe oligohydramnios had a higher incidence of Apgar scores below 7 at five minutes (p < 0.05). Conclusion: Severe oligohydramnios is strongly associated with non-reassuring fetal surveillance, increased operative delivery rates and adverse neonatal outcomes. Severity-based risk stratification and vigilant intrapartum monitoring are essential for optimizing fetomaternal outcomes.