Backrgound :Multi-vessel Doppler ultrasonography and biophysical profile scoring are theprincipal surveillance tools in pregnancies complicated by fetal growth restriction.The interpretation of these tests done concurrently may be complex.OBJECTIVE:This study examines the relationship between arterial and venous Doppler andBPP results in IUGR fetuses and correlates their abnormalities with umbilical arteryPH at birth to guide timing of delivery of these fetuses.DESIGN:Prospective observational study.PATIENTS and METHODS:50 patients diagnosed with intrauterine growth restriction (IUGR); all patientsunderwent uniform antenatal assessment protocol that includes a four componentbiophysical profile score and umbilical artery (UA), middle cerebral artery (MCA)and ductus venosus (DV) Doppler ultrasound studies. Most of the patients weredelivered by caesarean section. Samples were obtained from the umbilical cord forcord artery PH. Apgar scores at 1 and 5 minutes were recorded.OUTCOME:Correlation of Doppler results, BPP and cord blood PH were analyzed.RESULTS:There was no significant decrease in GA at time of termination in cases ofIUGR with abnormal DV-PIV compared to those with only abnormal UA-PI andMCA PI. Abnormal UA-Doppler was found in 19 patients (38%); 16 of them showedhigh PI (32%), 2 showed absent end diastolic flow (4%) and 1 showed reverseddiastolic flow (2%). Abnormal MCA Doppler was found in 8 patients (16%) andabnormal DV Doppler was found in 9 patients (18%). The Abnormal DV Doppler was significantly related to poor outcome parameter; pH < 7.20, low Apgar at 5-minand perinatal mortality; when compared with either Abnormal MCA or UA Doppler(p< 0.05). While there was no significant difference between MCA and UA Dopplerabnormalities in detecting poor outcome (p> 0.05), BPP was normal in 33 patients(66%), equivocal in 9 patients (18%) and abnormal in 8 patient (16%). The Abnormaland equivocal BPP were significantly related to poor outcome parameter; pH < 7.20,low Apgar at 5-min and perinatal mortality; when compared with normal BPP. (p<0.05).CONCLUSION:The conclusion of our study is that there is an important association betweenDV abnormalities and adverse neonatal outcomes suggesting that the assessment ofthis vessel is important to determine the timing of delivery. We also concluded thatmulti-vessel Doppler ultrasonography, and BPP can effectively stratify IUGR fetuseswith placental vascular insufficiency into risk categories.