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Background: Intrauterine growth restriction is one of the most common causes of perinatal morbidity and mortality worldwide. Strong evidence about the optimum method of surveillance is needed. Objective: to determine the relationship between biophysical fetal parameters and arterial and venous Doppler parameters in fetuses with severe intrauterine growth restriction (IUGR). Patients and Methods: This is a Prospective cohort study was conducted at Menoufia University Hospital during the period from March 2019 to September 2020. Fourty two IUGR fetuses with elevated Umbilical Artery (UA) Doppler had follow up with Doppler (UA, middle cerebral artery and ductus venosus) and Biophysical profile (BPP). Patients were stratified into three groups: G1: abnormal UA alone. G2: brain sparing effect. G3: abnormal DV Doppler. Our main primary outcome was neonatal intensive care unit (NICU) admission while secondary outcomes were APGAR score, Birth weight, EFW and stillbirth rate. Results UAEDV was present in 29 fetuses (69%), Absent/Reversed (AREDV) in 13 (31%). Brain sparing was observed in 18 fetuses (42.85%). Abnormal DV Doppler was noticed in 5 fetuses (11.9%). The BPP was > 6 in 28 fetuses (66.6%). Abnormal doppler (UA, MCA, DV) and abnormal BPP were significantly associated with increased NICU admissions, Still birth rates, lower APGAR scores, EFW and Birth weight. Multivariate regression analysis was performed, and it was found that abnormal MCA was the most associated parameter with NICU admission. Conclusion: Fetal Doppler (UA, MCA, DV) and BPP are complementary antenatal modalities. Therefore, pursuit of a combined testing approach has merit. [ABSTRACT FROM AUTHOR]