Background: Accurate prediction and management of abnormal fetal growth are crucial in antenatal care. Small for gestational age (SGA) foetuses face increased morbidity and mortality, while large for gestational age (LGA) foetuses risk birth trauma and perinatal morbidity.Objectives: To determine the correlation between first-trimester crown-rump length (CRL) measurements and maternal and neonatal outcomes.Materials and Methods: This retrospective cross-sectional study included 288 singleton pregnancies from July 1, 2022, to June 30, 2024. Patients underwent ultrasound examination between 11 to 13+6 weeks of gestation. Data were analysed using IBM SPSS Statistics version 23.Results: The study found significant associations between CRL measurements and neonatal outcomes. CRL values <44mm were linked to outcomes, including SGA (38.8%) and low birth weight (20.1%). In contrast, CRL values >81mm were associated with outcomes, including LGA (18.7%) and preterm births (11.11%). Maternal characteristics, such as parity, showed significant associations with CRL values.Conclusion: First-trimester CRL measurements are a valuable predictor of neonatal outcomes, including birth weight, SGA, LGA, preterm birth, and NICU admission. These findings emphasize the importance of early CRL measurement in identifying high-risk pregnancies and guiding prenatal care.