A retrospective analysis was performed to evaluate the role of sonographic measurement with umbilical and uterine artery Doppler studies in cases of suspected intrauterine growth retardation (IUGR). The sonogram was more sensitive (72%), but the umbilical artery Doppler scan was more specific (90%), for the diagnosis of IUGR. Abnormal uterine artery Doppler measurements in cases of IUGR diagnosed with a sonogram and umbilical artery Doppler scan were associated with chronic maternal hypertension. Those fetuses fared worse than those in which the uterine artery Doppler scans were normal. In contrast, small infants from pregnancies in which all three studies were normal performed well overall. Complementary use of these three studies to evaluate suspected IUGR fetuses may help us distinguish the small, troubled fetus from the small but healthy one.