Introduction: Fetal Growth Restriction (FGR) is associated with placental dysfunction. Placental Growth Factor (PlGF) can help in the prediction and timely diagnosis of FGR. This study aimed to evaluate the association between FGR, PlGF, and perinatal outcomes. Methods: Retrospective cohort of 292 patients. The primary exposure was maternal PlGF levels. Primary outcomes were fetal growth, abnormal sonographic placental morphology, preeclampsia, fetal demise (IUFD), preterm birth (PTB) < 34weeks, low birth weight, neonatal admission to NICU and placental pathology findings. Results: Normal-grown fetuses had longer pregnancies when compared to FGR pregnancies. Low PlGF levels were statistically significant and almost 5-fold higher among pregnancies with compromised fetal growth. There were 12.5-fold chance of IUFD in fetuses with compromised growth. Low birthweight was over ten times higher in growth-restricted fetuses. PTB < 34w and neonatal admission to NICU were also increased among patients with compromised fetal growth. Abnormal sonographic placental morphology was associated with fetal growth restriction. Preeclampsia was not associated with compromised fetal growth in this cohort. Abnormal placental pathology was increased 7-fold in growth-restricted fetuses. Conclusion: PlGF for the management of high-risk cases with compromised fetal growth is useful. The results confirm that compromised fetal growth is representative of placental dysfunction, associated with or without preeclampsia. In this context, PlGF testing has the potential to improve healthcare outcome in obstetrical care, especially in remote or low-resource settings.