Abstract Background: Fetal growth restriction (FGR) is a common-complication of pregnancy that is associatedwith a variety of adverse perinatal outcomes. Tadalafil is a selective PDE5 inhibitor with a longer half-life and a more rapid onset of action compared with sildenafil. Tadalafil treatment was feasible in pregnant women showing FGR. Aim of Study: This study aims to evaluate tadalafil as a prophylaxis to pregnancies at high risk for fetal growth restriction. Patients and Methods: This study was carried out on 30 pregnant women attending Emergency Unit of Obstetrics and Gynecology Department, Zagazig University Hospitals. This group of patients was selected according to both present and past medical disorders and past obstetric history. Results: Our results showed statistically significant dif-ferences in umbilical artery Doppler indices before, two hours and six hours following tadalafil therapy in the studied patients (p<.05). Also, there were statistically significant differences in middle cerebral artery Doppler indices before, two hours and six hours following tadalafil therapy in the studied patients (p<.05). Conclusion: Tadalafil treatment may offer a promising therapy for fetal growth restriction with placental insufficiency.