Introduction:Most common complication of pregnancy is intrauterine growth restriction which is associated with perinatal mortality, morbidity and neurological impaired development. Doppler of Uterine, umbilical, middle cerebral arteries and cerebro-placental ratio are commonly done for intrauterine growth restriction evaluation. The aim of the study was to evaluate the diagnostic performance of fetal middle cerebral artery and umbilical artery by Doppler ultrasonography in high risk mothers and correlation with perinatal outcome. Material and Methods: Fifty singleton pregnancies beyond 28 weeks of gestation complicated by intrauterine growth restriction were prospectively examined with Doppler ultrasound of umbilical and middle cerebral arteries. Results: 40 of the 50 cases included in the study had adverse outcome. The sensitivity of Doppler of the umbilical artery using Pulsatility index was 82.5%, middle cerebral artery Pulsatility index was 77.5% and ratio of middle cerebral artery Pulsatility index / umbilical artery Pulsatility index was 87.5% in predicting perinatal outcome. Conclusion: Pulsatility index ratio of middle cerebral artery / umbilical artery is the most sensitive index in predicting perinatal outcome (87.5%). Umbilical Systolic /Diastolic ratio is the most specific index (80.9%). Absent and reversed diastolic flow in umbilical artery in prenatal sonography carries grave prognosis and high mortality of fetus. Combined use of both umbilical and middle cerebral arterial doppler study including the cerebro-placental ratio increase the sensitivity of the doppler studies for prediction adverse perinatal outcome.