Background: Cardiotocography (CTG) is considered to be a non-invasive prenatal screening technique. It is used to monitor fetal condition during labor. Objectives: this study aimed to evaluate the role of Cardiotocography as a screening tool during labor in high risk pregnancy for determining perinatal outcomes. Methods: In this cross-sectional study, Cardiotocography was performed randomly on 200 pregnant women with risk factors (postdate, oligohydronomia, Pregnancy-induced hypertension, diabetes mellitus, anemia, intrauterine growth retardation, Antepartum hemorrhage, and pre-labor rupture of membrane who attended the labor ward of Duhok Teaching Hospital of Obstetrics and Gynecology from 20 October 2019 to 15 February 2020 and the results of CTG were categorized a reactive and non-reactive cardiotocography tracing groups and the perinatal outcomes were correlated with cardiotocography results. Results: In this study, the mean age of patients was 27.41±6.09 years; ranged 18-42 years. There was no significant difference in the mean age of the patients (27.48±6.17 vs. 27.33±6.05 years), gravida (2.49±1.73 vs. 2.10±1.53) and gestational age (39.85±1.40 vs. 39.84±1.41weeks) between patients with reactive and non-reactive cardiotocography tracing, respectively. Patients with reactive cardiotocography were significantly more likely to have live babies (1.52±1.77 vs. 0.54±0.67) and no dead babies was recorded between reactive and non-reactive cardiotocography groups. The rate of caesarean section was significantly higher in patients with non-reactive cardiotocography (64.4% vs. 38.4%) and for bloody liquor (7.9% vs. 2.0%). It was also observed that low Apgar score 0-4 in first minute (12.9% vs. 4.0%) and 5-7 Apgar score in five minutes (34.7% vs. 9.1%) and admission to neonatal intensive care unit were significantly higher in patients with non-reactive than in those with reactive cardiotocography (59.4% vs. 26.3%), respectively. Conclusions: This study showed that cardiotocography is a useful technique to determine perinatal outcomes in high-risk pregnancies.