Multi-vessel Doppler ultrasonograph, cardiotococraphy andbiophysical profile scoring are the principal surveillance tools inpregnancies complicated by fetal growth restriction. The interpretation ofthese tests done concurrently may be complex. This study examines the relationship between arterial and venousDoppler, BPP and CTG results in IUGR fetuses and correlates theirabnormalities with umbilical artery PH at birth to guide timing of deliveryof these fetuses. It is a prospective observational study. Setting : Fetal Medicine Unit, Department of Obstetrics and Gynecology-Cairo University Hospitals-Kasr El Aini. 50 patients diagnosed with intrauterine growth restriction (IUGR);all patients underwent uniform antenatal assessment protocol that includesa four component biophysical profile score, cardiotocography andumbilical artery (UA), middle cerebral artery (MCA) and ductus venosus(DV) Doppler ultrasound studies.All patient were delivered by caesarean section. Samples wereobtained from the umbilical cord for cord artery PH. Apgar scores at 1 and5 minutes were recorded. Correlation of Doppler results, BPP, CTG and cord blood PH wereanalyzed. There was no significant decrease in GA at time of termination incases of IUGR with abnormal DV-PIV compared to those with onlyabnormal UA-PI and MCA PI. Abnormal UA-Doppler was found in 19patients (38%); 16 of them showed high PI (32%), 2 showed absent end diastolic flow (4%) and 1 showed reversed diastolic flow (2%). AbnormalMCA Doppler was found in 8 patients (16%) and abnormal DV Doppler wasfound in 9 patients (18%). The Abnormal DV Doppler was significantlyrelated to poor outcome parameter; pH < 7.20, low Apgar at 5-min andperinatal mortality; when compared with either Abnormal MCA or UADoppler (p< 0.05). While there was no significant difference between MCAand UA Doppler abnormalities in detecting poor outcome (p> 0.05). BPPwas normal in 33 patients (66%), equivalent in 9 patients (18%) andabnormal in 8 patient (16%). The Abnormal and equivalent BPP weresignificantly related to poor outcome parameter; pH < 7.20, low Apgar at 5-min and perinatal mortality; when compared with normal BPP. (p< 0.05).CTG was reactive in 31 patients (62%), non reactive in 10 patients (20%)and showed loss of variability in 9 patients (18%). Loss of variability andnon reactive CTG were significantly related to early GA at delivery, poorApgar score at 1 and 5 min when compared with reactive CTG (p<0.05).But these were of no significance in detecting PH < 7.2 (p>0.05). The conclusion of our study is that there is an important associationbetween DV abnormalities and adverse neonatal outcomes suggesting thatthe assessment of this vessel is important to determine the timing of deliveryespecially premature as once DV-PIV is elevated 2 SD above the meandelivery is indicated provided that the fetus has a good chance of postnatalsurvival. We concluded also that multi-vessel Doppler ultrasonography,CTG and BPP can effectively stratify IUGR fetuses with placental vascularinsufficiency into risk categories. When applied together, the pattern ofresults is not perfectly consistent. Fetal deterioration appears to beindependently reflected in these testing modalities: their combined use islikely to be complementary.