Introduction: The amniotic fluid index (AFI) plays a crucial role in predicting the optimal timing for delivery and assessing the risks of adverse outcomes for both the mother and fetus. Therefore, our study aimed to investigate whether a low AFI during pregnancy could serve as a predictor of adverse perinatal outcomes in normally progressing pregnancies, and to identify a specific AFI threshold that could reliably predict such outcomes. Materials and Methods: This observational study enrolled 145 pregnant women at term gestation presenting at the Department of Obstetrics and Gynecology. Comprehensive history-taking and clinical examinations were performed, and AFI was assessed using ultrasound imaging. Results: Among the 100 pregnant women included in the study, 37.93% had an AFI of less than 5. A low AFI was significantly associated with the need for cesarean section (LSCS), as well as a negative fern test (p<0.05). Furthermore, a low AFI was significantly linked to lower birth weight, reduced APGAR scores at 1 and 5 minutes postpartum, and an increased likelihood of neonatal intensive care unit (NICU) admission (p<0.05). The receiver operating characteristic (ROC) curve analysis demonstrated that the AFI <5 demonstrated optimal sensitivity and specificity for predicting NICU admission, followed by LSCS (p<0.05). Conclusion: The AFI serves as a critical factor in determining adverse outcomes for both the mother and fetus during pregnancy. An AFI of less than 5 is associated with increased maternal risks such as higher rates of operative delivery, and adverse fetal outcomes including low birth weight, meconium-stained amniotic fluid, low APGAR scores, and an elevated likelihood of NICU admission. Comprehensive intrapartum monitoring and fetal surveillance strategies are essential to mitigate these adverse perinatal outcomes.