Fetal growth restriction (FGR) is frequently associated with uteroplacental insufficiency. Placental lakes are avillous spaces filled with maternal venous blood that usually do not compromise the pregnancy outcome; however, a few reports describe FGR in association with placental lakes. Reversed middle cerebral artery (MCA) end-diastolic flow is a rare event and a potential indicator of poor fetal outcome due to placental insufficiency. We report a case of severe FGR associated with a huge subchorionic placental lake concomitant with reversed MCA end-diastolic flow. We also conducted a literature review.