Intrauterine growth restriction (IUGR) is one of the major contributors to perinatal mortality and morbidity and is characterized by complex hemodynamic changes involving placental and fetal arterial, cardiac and venous circulations .However, the temporal sequence of these modifications in relation to other hemodynamic changes of the fetal arterial and venous circulations is unknown.

The aim of this study was to evaluate cardiac function and other hemodynamic changes in a group of fetuses with IUGR and clinical impact on perinatal outcome .

Inclusion Criteria:

• Singleton fetus with normal fetal anatomy documented a detailed sonogram.
• Fetal abdominal circumference <5th percentile for gestational age.
• Evidence of placental insufficiency documented by an elevated umbilical artery pulsatility index (UA-PI) by reference ranges.

Exclusion Criteria:

• evidence of fetal infection
• chorioamnionitis
• fetal anomalies
• abnormal fetal karyotype
• patient withdrawal from the study and/or unavailability for follow-up.

observational study conducted at academic perinatalcenter that investigates relationships between antenatal testing parameters and outcome in IUGR fetuses Patients who give written consent to participate in the study undergo a uniform antenatal assessment protocol that includes umbilical artery (UA), middle cerebral artery (MCA) and ductus venosus (DV) Doppler ultrasound studies as well as detailed fetal echocardiography and five-component biophysical profile score.

- Criteria for study eligibility are:

• Singleton fetus with normal fetal anatomy documentedon a detailed sonogram.
• Fetal abdominal circumference <5th percentile forgestational age.•
• Evidence of placental insufficiency documented by an elevated umbilical artery pulsatility index (UA-PI) by reference ranges.