Background: Maternal monitoring of fetal movement is a mean of screening fetal status. The rationale is based on the assumption that early recognition of decreased fetal movement (DFM) makes it possible for the clinician to intervene at a stage when the fetus is still compensated, and thus prevent progression to fetal or neonatal injury or death. Objective: To evaluate the role of non-stress test and umbilical artery Doppler measurements as an antenatal screening test for assessment of fetal well-being in high risk pregnancies affected by decreased fetal movements. Patients and methods: The current study enrolled 200 patients complaining of decreased fetal movements came for ante natal care in ante natal care clinic of Al Azhar Assiut University Hospital. Enrolled women were randomly allocated in two equal groups, the study continued for 1 year (from January 2019 – December 2019). Results: This study shows that the use of umbilical artery Doppler ultrasound assessment as an antenatal screening test was associated with a reduction in the incidence of cesarean delivery for fetal distress, more successful induction of labor, less admissions to NICU and better APGAR score in high risk pregnant population complaining of decreased fetal movement compared to non-stress test. Conclusion: Umbilical artery Doppler ultrasound assessment of the fetus in conjunction with a policy of directed intervention resulted in a decrease in the rate of cesarean delivery for fetal distress in a high-risk pregnancy, when compared with the NST.