Background: The assessment of fetal hemodynamic status via Doppler flow is increasingly regarded as likely to aid in the detection of pregnancies at risk of developing adverse fetal outcomes. Doppler flow provides useful information beyond the ultrasound-based assessment of fetal growth alone. Objective: This study aimed to evaluate the role of cerebro-placental ratio (CPR) in prediction of perinatal outcome in preeclamptic patients with intrauterine growth restriction (IUGR). Patients and methods: This case-control study was conducted at Obstetrics and Gynecology Department, Zagazig University, on 50 pregnant women divided in to two groups: Group I (study group) that included 25 high risk pregnant women with IUGR. Group II (control group) included 25 high risk pregnant women without IUGR. The study was conducted during the period from December 2020 till July 2021. Results: The current study showed that CPR had 90.9% sensitivity, 78.6% specificity and 84 % diagnostic accuracy to predict newborns with low Apgar score, with statistically significant positive correlation. CPR also had 100% sensitivity, 100% specificity and 100 % diagnostic accuracy to predict stillbirth, with highly statistically significant positive correlation. The CPR had 100% sensitivity, 83.3% specificity and 92 % diagnostic accuracy to predict newborns with NICU admission, with statistically significant positive correlation. Other complications as meconium aspiration and neonatal death had no statistically significant to be predicted by low CPR. Conclusion: This study concluded that the Cerebro-Placental Ratio had high predictive value of perinatal out come in preeclamptic patients.