Introduction: Doppler ultrasound velocimetry of uteroplacental umbilical and fetal vessels has become established method of antenatal monitoring. Cerebroplacental ratio has been studied to predict neonatal outcomes.  Aim of the work: Our aim was to assess role of cerebro-placental ratio in prediction of perinatal outcome in high-risk pregnancies with intrauterine growth restriction.  Patients and Methods: In this study was held in Ain Shams university maternity hospital which included 60 high risk pregnant women divided in to two groups: Group I: study group: 30 high risk pregnant women with IUGR, Group II- control group: 30 high risk pregnant women without IUGR.  Results: The current study showed that among patients with IUGR and low CPR, 17 (56.7%) had CS for fetal distress, 12 (40.0%) had neonate with low APGAR, 13 (43.3%) had neonatal meconium aspiration, 6 (20.0%) had neonatal Hypoxic ischemic Encephalopathy, 15 (50.0%) had neonate need NICU admission, 3 (10.0%) had neonatal death, 1 (3.3%) had neonatal still birth. The current study showed that among patients without IUGR and low CPR, 8 (26.7%) had CS for fetal distress, 5 (16.7%) had neonate with low APGAR, 4 (13.3%) had neonatal meconium aspiration, 1 (3.3%) had neonatal Hypoxic ischemic Encephalopathy, 5 (16.7%) had neonate need NICU admission, 1 (3.3%) had neonatal death, 0 (0.0%) had neonatal still birth. Conclusion: Cerebro -placental ratio has high predictive value of perinatal outcome in high risk pregnancy with intrauterine growth restriction.