Background: Doppler velocimetry studies of the fetal umbilical artery (UA) in the antenatal period have been shown to be correlated with significant intrauterine growth restriction, subsequent intrapartum fetal distress requiring intervention, and other major adverse perinatal outcome. The addition of middle cerebral Doppler (MCA) studies and expression of the two parameters as a ratio has been shown to predict intrauterine growth restriction (IUGR) sensitively. However, an abnormal ratio was not shown to be associated with increased risk of major perinatal morbidity or mortality or subsequent neurological damage. This study aims at evaluating the correlation between the UA/MCA Doppler ratio and adverse perinatal outcome in a group of term fetuses with suspected IUGR when the umbilical Doppler findings were still largely within the normal range.Methods: A retrospective analysis of all pregnancies undergoing ultrasound and Doppler studies for evaluation of suspected IUGR after 34 weeks over a period of 6 months in a general obstetric unit that catered for an annual delivery of around 3500 deliveries per year. The data from the ultrasound and Doppler evaluation within 1 week from delivery were analyzed. Those with absent or reversed end diastolic flow, or a systolic/diastolic (S/D) ratio over 3.5 in UA Doppler studies were excluded from analysis. The S/D ratio of UA and MCA Doppler findings were then expressed as a ratio, and these were correlated with the perinatal events and immediate neonatal outcome parameters.Results: A total of 123 babies with complete data were included in the analysis, of which 10 were from five twin pregnancies. Seventy‐two (58.5%) were confirmed to be growth restricted with birth weight below the 10th percentile for gestation. Sixteen (13%) had an UA/MCA Doppler ratio under 0.75. The incidence of IUGR was significantly higher in this group with abnormal Doppler ratio (87.5%) as compared to the normal ratio group (55%) (P < 0.05). Similarly, the abnormal Doppler ratio group had higher incidence of significant oligohydramnios (75% vs. 17%, P < 0.001), induction of labor (50% vs. 20%, P < 0.01), total cesarean section (62.5% vs. 15.8%, P < 0.001), and cesarean section for fetal distress (43% vs. 11.2%, P < 0.001) than the normal ratio group. The incidence of admission to NICU, meconium stained liquor or intrapartum cardiotocogram abnormalities did not differ.Conclusion: In the presence of normal UA Doppler findings, early changes of cerebral vasodilation leading to a relatively low UA/MCA Doppler ratio are associated with a higher incidence of obstetric intervention and perinatal morbidity. The MCA Doppler studies should be valuable in the evaluation of suspected growth restriction even when UA Doppler findings are largely normal.