Background: Abstract Uteroplacental Insufficiency (UPI) is a major cause of Intrauterine Growth Restriction (IUGR), preeclampsia, oligohydramnios and adverse perinatal outcomes. Early detection is critical for guiding timely interventions. Conventional methods such as biometry and cardiotocography often identify compromise late in the disease process, whereas Doppler ultrasound offers a sensitive, non-invasive modality to evaluate maternal and fetal circulations in real time. Aim: This study aimed to assess the role of uterine, umbilical and middle cerebral artery Doppler indices, as well as Cerebroplacental Ratio (CPR), in predicting UPI and related complications. Patients and Methods: A prospective case–control study was conducted at the Radiology Department, Azadi Teaching Hospital, Kirkuk, Iraq, from January 2023 to May 2024. A total of 120 pregnant women between 24 and 40 weeks were enrolled, including 60 high-risk cases and 60 healthy controls. All participants underwent standardized Doppler evaluation of the uterine arteries, umbilical artery and middle cerebral artery. Results: Uterine artery PI (1.42±0.25 vs. 0.98±0.18, p<0.001) and RI (0.68±0.09 vs. 0.54±0.08, p<0.001) were significantly elevated in cases, with bilateral notching observed in 33.3% versus 3.3% of controls (p<0.001). Umbilical artery PI (1.20±0.22 vs. 0.89±0.17, p<0.001) and RI (0.71±0.07 vs. 0.59±0.06, p<0.001) were similarly increased, with absent/reversed end-diastolic flow present in 10.0% of cases. MCA PI was significantly lower in cases (1.38±0.20 vs. 1.64±0.23, p<0.001), while CPR was reduced (0.95±0.14 vs. 1.42±0.20, p<0.001), with abnormal CPR (<1) observed in 43.3% of cases versus 3.3% of controls (p<0.001). Abnormal Doppler findings were strongly associated with IUGR (30.0% vs. 2.5%), oligohydramnios (25.0% vs. 5.0%), preterm delivery (35.0% vs. 7.5%) and cesarean section (50.0% vs. 22.5%) (all p<0.01). Logistic regression identified CPR <1 as the most powerful predictor of UPI (OR 7.8, 95% CI 2.6–23.4, p <0.001), followed by MCA PI <5th percentile (OR 5.2, 95% CI 1.9–13.7, p = 0.001). Conclusion: Doppler ultrasound is a reliable, non-invasive tool for detecting uteroplacental insufficiency and predicting adverse outcomes in high-risk pregnancies. Multiparametric evaluation incorporating uterine, umbilical and cerebral Doppler, particularly CPR, enhances diagnostic accuracy.