Background: Fetal surveillance of the pregnancies that are complicated by IUGR is essential to improve fetal outcome. Colour Doppler studies of uteroplacental and fetoplacental circulation are useful in identification of hypoxemic status of the fetus and allows timely intervention in at risk fetuses. The present study was aimed to know the significance of colour Doppler studies in intrauterine growth restriction cases and to correlate with the perinatal outcome thus to offer better strategies for early diagnosis of compromised fetus and timely intervention.Methods: This was a prospective study of 125 singleton pregnancies in the third trimester with IUGR. The results of last Doppler ultrasound within one week of delivery were used for analysis. Adverse perinatal outcome was studied in the form of emergency cesarean section for fetal distress, meconium stained amniotic fluid, Apgar at 5 min <7, NICU admission and perinatal mortality (stillbirths and neonatal death). Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and Diagnostic accuracy of various Doppler parameters were calculated after comparing with standard.Results: In the present study 63 patients had one or more adverse perinatal outcome parameter. The diagnostic accuracy of umbilical artery was more (71.20%) than other parameters in predicting adverse perinatal outcome. Middle cerebral artery RI was having highest specificity and positive predictive value of 100% than any other parameter in predicting adverse perinatal outcome. Patients with AEDF and REDF had 33.3% and 50% perinatal deaths respectively.Conclusions: Middle cerebral artery Doppler studies shown more specificity and positive predictive value than umbilical artery Doppler in prediction of adverse perinatal outcome.