BACKGROUND: Multi-vessel Doppler ultrasonography is the principal surveillance tools in pregnancies complicated by fetal growth restriction. OBJECTIVE:To determine diagnostic accuracy of the fetal umbilical artery, middle cerebral artery pulsatility indices and their ratio in intrauterine growth restricted fetuses. PATIENTS and METHODS: Forty patients were studied that had been diagnosed clinically and ultrasonographically as intra-uterine growth restriction (IUGR). All patients in the study underwent uniform antenatal assessment protocol that includes umbilical artery (UA) and middle cerebral artery (MCA) Doppler ultrasound studies. These were conducted either twice weekly or daily according to the severity of the condition. RESULTS: Abnormal UA PI was found in 25 cases, 11cases due to maternal cause , 5 cases due to placental cause , 9 cases with idiopathic cause of the IUGR group . Abnormal MCA PI was found in 26 cases,11 cases due to maternal cause , 5 cases due to placental cause , 10 cases with idiopathic cause of the IUGR group. Abnormal C/U Ratio was found in 24 cases,11 cases due to maternal cause, 5 cases due to placental cause , 8 cases with idiopathic cause of the IUGR group . CONCLUSION: Among the Doppler indices, the C/U ratio is a better predictor of IUGR fetuses than either the UAPI or the MCA PI alone, with a high specificity and PPV. However, measurement of the UAPI (among all the Doppler indices) is enough to detect IUGR per se, probably because UAPI is a direct reflection of the resistance in the placental vascular bed.