Background: Fetal heart rate (FHR) monitoring has caused a clinical dilemma due to widespread misinterpretation of the physiology influencing various FHR patterns and the development of cerebral palsy. This study aimed to correlate various category II FHR patterns with maternal risk factors and birth outcomes. Methods: This prospective observational study was conducted at SRM Medical College Hospital and Research Center, Kattankulathur, Chennai, from December 2020 to March 2022. A total of 150 parturients with category II cardiotocography (CTG) were studied, and all were followed up through delivery and in the neonatal period. Results: Of the pregnant mothers, 79.9% were aged between 21 and 29 years. Most patients were primigravida 113 (75.3%), and 97 (64.7%) were in the early term (37w–38w 6d). On studying the association between maternal risk factors and category II CTG, 68% had an associated risk factor. In our study, intrauterine resuscitation maneuvers did not help in improving the abnormal fetal heart pattern. Variable deceleration was the most commonly encountered CTG abnormality (50.7%). Common category II CTG abnormalities with risk factors were variable deceleration followed by tachycardia, minimal beat-to-beat variability, and bradycardia. The most common category II CTG abnormality associated with induced labor was tachycardia, and with spontaneous labor, it was variable deceleration with good beat-to-beat variability which was statistically significant. The difference in the mode of delivery between the different CTGs was statistically significant. The difference in the APGAR score and cord blood pH between CTG abnormalities was statistically significant. Conclusion: In our study, there was higher correlation seen between minimal beat-to-beat variability, tachycardia, and variable decelerations with adverse neonatal outcomes and when present should be carefully monitored and decision to be taken accordingly.