Objective <p>This study aimed to compare uncomplicated pregnancies and pregnancies complicated by late-onset fetal growth restriction (FGR) in terms of myocardial performance index (MPI) and renal artery pulsatility index (PI), and to explore whether these parameters are associated with adverse perinatal outcomes.</p> Study design <p>This prospective case–control study included 46 uncomplicated pregnancies and 51 pregnancies with late-onset fetal growth restriction. A composite adverse perinatal outcome was defined by the presence of stillbirth, neonatal death, any Apgar score &lt; 7, need for neonatal resuscitation, umbilical cord pH &lt; 7.1, or admission to the neonatal intensive care unit.</p> Results <p>Renal artery PI and MPI values did not differ significantly between pregnancies with late-onset FGR and uncomplicated pregnancies. In the entire cohort, a weak positive correlation was observed between renal artery PI and umbilical cord pH (<i>r</i> = 0.206, <i>p</i> = 0.044), while MPI was negatively correlated with birthweight (<i>r</i> = − 0.340, <i>p</i> = 0.001). Exploratory receiver operating characteristic analyses demonstrated limited discriminative performance of both renal artery PI and MPI for adverse perinatal outcomes.</p> Conclusion <p>Renal artery PI and MPI do not appear to have sufficient predictive value for adverse perinatal outcomes in late-onset FGR. Although MPI was higher in pregnancies complicated by late-onset FGR and showed an association with birthweight, its clinical utility as a standalone diagnostic parameter appears limited.</p>