To elucidate the association between Doppler parameters and histological signs of placental underperfusion (PUP) in late-onset small-for-gestational age (SGA) babies. The umbilical and middle cerebral arteries, uterine arteries (UtA), and umbilical vein blood flow (UVBF) were evaluated before delivery in a cohort of 95 SGA singleton fetuses delivered after 34 weeks' gestation. For each case, the placenta was histologically evaluated for signs of PUP using a hierarchical and standardized classification system. The independent association of the Doppler parameters to PUP was evaluated using logistic regression and decision tree analysis. In 51 cases (53.7%), 61 placental histological findings were qualified as signs of PUP. These cases had a significantly higher incidence of Caesarean section (CS) for non-reassuring fetal status (49% vs. 11.4%; p < 0.001) and neonatal metabolic acidosis at birth (21.6% vs. 0%; p = 0.001). Significant and independent contributions to PUP lesions were provided by the mean UtA pulsatility index (PI; p = 0.018, OR 2 [95%CI: 1.1-3.7]) and UVBF normalized to estimated fetal weight (p = 0.027, OR 0.97 [95%CI: 0.95-0.99]). The combination of both parameters revealed three groups with differing risk for PUP: normalized UVBF >82 mL/min/kg (risk 31.2%), normalized UVBF ≤82 mL/min/kg and mean UtA-PI ≤95th percentile (risk 65.5%), and normalized UVBF ≤82 mL/min/kg and UtA-PI >95th percentile (risk 94.4%). In late-onset SGA pregnancies, uterine Doppler and umbilical vein flow are surrogates for PUP. These findings facilitate phenotypic profiling of fetal growth restriction cases among the general population of late-onset SGA.