Aims and objectives: To evaluate the usefulness of Pulsatility Indices (PI) of the Umbilical Artery (UA), Fetal Middle Cerebral Artery (MCA) and ratio of the Middle Cerebral Artery PI to the Umbilical Artery PI (Cerebroplacental Ratio) in the diagnosis of Intrauterine Growth Restriction fetuses and in the prediction of adverse perinatal outcome. Material and methods: Study was performed on 100 women with singleton non-anomalous pregnancy of 31-40 weeks gestation that were clinically suspected IUGR. Fetal biometry, amniotic fluid assessment, estimated fetal weight (EFW) and Doppler indices including UA PI, MCA PI, and cerebroplacental ratio were assessed. Perinatal outcomes assessed were LSCS for fetal distress, APGAR < 7 at 5 minutes, NICU admissions and perinatal death. Results: Cerebroplacental ratio had a higher sensitivity (84.1%), specificity (82.1%), positive predictive value (78.7%), negative predictive value (86.7%) for the diagnosis of IUGR, than that of pulsatility indices of Middle Cerebral Artery or Umbilical Artery separately. AUROC characteristics for the diagnosis of IUGR with use of the CPR (p less than 0.0001) were statistically significant than UA PI (p less than 0.0001) and MCA PI (p 0.002). The AUROC curve for CPR, UA PI and MCA PI were 0.835, 0.811 and 0.679 respectively. For the prediction of adverse perinatal outcome, Cerebroplacental ratio had a higher sensitivity (93.3%), specificity (90.9%), positive predictive value (89.3%), negative predictive value (94.3%) than that of pulsatility indices of Middle Cerebral Artery or Umbilical Artery separately. Conclusions: Cerebroplacental Ratio (CPR) is a superior diagnostic tool for identifying Intrauterine Growth Restriction (IUGR) and predicting adverse perinatal outcome when compared to the Umbilical Artery Pulsatility Index (UA PI) and Middle Cerebral Artery Pulsatility Index (MCA PI)