Background: Identifying damaged intrauterine growth restriction (IUGR) fetuses quickly and offering timely intervention is one of the main goals of the prenatal care services that are now in place. Aim: To compare myocardial performance index (MPI) values among growth restricted and normal growing fetuses and to establish if these values are associated with the severity of growth restriction and poor outcomes. Patients and Methods: Eighty expectant women participated in this cohort study. Forty were assigned to the study group and were diagnosed with growth-restricted fetal syndrome, while another forty were assigned to the control group and were diagnosed with normally developing fetuses. All expectant women underwent fetal echocardiography in order to evaluate the modified MPI. Ultrasound parameters for the umbilical, middle cerebral, ductus venosus, and uterine artery were assessed using Doppler methods. Results: IUGR fetuses had a significantly greater myocardial performance index than controls. The admission rates to the neonatal ICU were notably greater in IUGR infants contrasted to control group (P <0.001). At a cutoff value of 0.52, the modified MPI demonstrated a sensitivity of 88.9% and a specificity of 84.1% in its ability to predict adverse outcomes. Birth weights were significantly inversely correlated with modified myocardial performance index values. Conclusions: MPI values appeared to be associated with the severity of FGR, as they were elevated in FGR pregnancies. A greater MPI value may be predictive of unfavorable outcomes, such as reflex cardiac dysfunction in FGR.