We report four cases of uteroplacental insufficiency with severe intrauterine growth retardation in which coronary blood flow was demonstrated by means of color-coded and pulsed wave Doppler sonography. Intrauterine fetal compromise was indicated by pathological uterine and umbilical flow indices and decreased impedance in the cerebral vasculature. Later, this was followed by normalization of middle cerebral artery Doppler indices in one case. The latter change was associated with abnormal atrial systolic reverse blood flow initially in the inferior vena cava, then in the ductus venosus and finally resulting in pulsatile flow in the umbilical vein. In the late stage of fetal deterioration pulsatile flow in the umbilical vein was replaced by a biphasic flow pattern. In two cases coronary flow was visualized preceding intrauterine fetal death. In the two other cases a severely growth retarded newborn was delivered by Cesarean section. The postnatal course was complicated by a prolonged period of circulatory insufficiency and renal failure and in one case by a persistent ductus arteriosus. Visualization of fetal coronary blood flow in severe uteroplacental insufficiency could be a preterminal event when urgent delivery may be warranted.