Objective: The objective of this study is to evaluate the association between birth weight centiles and the risk of intrapartum compromise and adverse neonatal outcomes in term pregnancies. Methods: Retrospective study of 32 468 term singleton births at a major tertiary maternity hospital in Australia. Data comprised gestation, mode, and indication for delivery and adverse perinatal outcomes. Fetal sex and gestational age-specific birth weight centiles were the main exposure variable. Results: Neonates <21st birth weight centile had an increased risk of intrapartum compromise, the highest risk was in babies <3rd centile (OR 4.04, 95% CI 3.34–4.89). The risk of adverse perinatal outcomes was increased in neonates <21st and >91st birth weight centiles. The highest risk was in those <3rd centile (OR 2.35, 95% CI 2.00–2.75). Conclusions: Fetal size measurements near term may be used as part of screening test for identifying fetuses at an increased risk of intrapartum compromise and adverse perinatal outcomes.