Background: Serial obstetric ultrasonography enables objective monitoring of fetal biometry and supports timely recognition of abnormal growth trajectories. Objectives: To describe third-trimester fetal growth patterns on ultrasound and examine their association with maternal risk factors. Methods: In this prospective observational study, 100 pregnant women were enrolled and followed until delivery. Standardized fetal biometry (BPD, HC, AC, FL) and EFW were recorded on serial scans, with umbilical artery Doppler assessment in the final evaluation. Fetuses were categorized as appropriate, small, or large for gestational age using centile-based definitions. Maternal anemia, gestational hypertension, GDM, and undernutrition were documented from antenatal records. Results: The mean maternal age was 26.9 ± 4.3 years and the mean gestational age at recruitment was 21.8 ± 4.6 weeks. On the final scan, 68% of fetuses were appropriate for gestational age, 22% were SGA, and 10% were LGA. Reduced AC was the most frequent finding among SGA fetuses (81.8%), and elevated umbilical artery pulsatility index was observed in 36.4%. SGA occurred more often among anemic women (42.1%) than among non-anemic women (9.7%), while LGA was more frequent among women with GDM (33.3%) than among those without diabetes (4.9%). Conclusion: Maternal anemia and hypertensive disorders clustered with growth restriction patterns, whereas GDM was linked to fetal overgrowth. Combining maternal risk profiling with serial biometry and Doppler supports antenatal risk stratification.