ABSTRACT Objective To examine the contribution of different ultrasonographic fetal growth phenotypes to adverse perinatal outcomes at term. Design Retrospective population-based cohort study. Setting John Radcliffe Hospital, Oxford, where universal ultrasound at 35 +1-36 +6 weeks is performed. Population Congenital abnormalities and births before the scan were excluded. Singleton fetuses were categorized as five mutually exclusive phenotypes using a hierarchical approach: 1. ISUOG fetal growth restriction (FGR), according to Delphi criteria; 2. Constitutional small-for-gestational-age (SGA) (estimated fetal weight [EFW] <10 th centile); 3. Appropriate-for-gestational-age (AGA) with either cerebroplacental ratio <5 th centile or umbilical artery > 95 th centile; 4. AGA with slowing abdominal circumference growth velocity (ACGV <10 th centile); 5. Normal AGA; Methods Univariate logistic regression was employed using normal AGA as reference group. Group differences were assessed using the chi-square test and ANOVA. Main outcome measures Stillbirth (SB); composite adverse outcome (CAO) (1+ of Grade 2-3 encephalopathy, cooling, ventilation >24 hours, or perinatal death); severe SGA at birth; neonatal unit admission; obstetric interventions. Results Among 45179 pregnancies, 54 SBs (0.1%) and 253 CAOs (0.6%) occurred. Normal AGA fetuses at the 35 +1-36 +6 week scan accounted for 82% of all pregnancies and for 43 (79.6%) SBs and 205 (81%) with the CAO, yet only 37.3% of neonates born with severe SGA. The absolute risk of SB and CAO was similar in all groups (0.1-0.2%), with the highest intervention rates in Group 1. Conclusions Term FGR and ‘normal’ babies have similar perinatal risks, presumably because of intervention. Despite a detection rate of 62.7% for severe SGA, most adverse outcomes occurred in pregnancies with a normal scan. Funding Oxford Hospitals Charity. Registered charity number 1175809