Objectives: To investigate outcome of intrauterine growth restriction (IUGR) fetuses in relation to the features of middle cerebral artery pulsatility index (MCA PI) and umbilical artery pulsatility index (UA PI) ratio. Methods: Fifty-four singleton pregnant women who delivered IUGR fetuses were enrolled. The ratios of MCA PI to UA PI were measured. There were classified patients into 2 groups, group 1 with normal MCA/UA PI ratio (MCA/UA PI > 1.08) and group 2 with abnormal MCA/UA PI ratio. Adverse perinatal outcome as neonatal intensive care unit admission, Apgar score at 1 min < 7, need for ventilators, respiratory distress syndrome and need for blood transfusion were compared between 2 groups. Results: Of the 54 pregnancies in this study, 37 patients (68.5%) were classified into group 1 and 17 patients (31.5%) into group 2. There were significantly higher adverse perinatal outcome in group 2 (P values < 0.05). Conclusions: IUGR fetuses with abnormal MCA/UA PI ratio suffered more morbidity than with normal MCA/UA PI ratio. The MCA/UA ratio is a good predictor of adverse perinatal outcome