Objective To investigate the significance of ultrasound detection of fetal middle cerebral artery (MCA), umbilical artery (UmA) blood flow and maternal uterine artery (UtA) blood flow in diagnosing fetal distress. Methods 62 pregnant women with suspected intrauterine distress admitted to our hospital from January 2021 to December 2023 were selected as the study group. Meanwhile, 62 pregnant women who underwent physical examination in our hospital during the same period were selected as the control group. Fetal MCA, UmA and pregnant women"s UtA blood flow were detected by ultrasound in both groups. The hemodynamic parameters (resistance index (RI), pulsation index (PI), maximum systolic flow velocity and end-diastolic flow velocity ratio (S/D)) of UmA, MCA and UtA in the two groups were analyzed and compared. Taking delivery outcome as the "gold standard" for diagnosing fetal distress, the diagnostic results and diagnostic efficiency of fetal MCA, UmA and UtA alone and in combination were analyzed. Results Compared with the control group, the RI, PI and S/D values of MCA in the study group were significantly decreased (P < 0.05). The RI, PI and S/D values of fetal UmA and maternal UtA in the study group were significantly higher than those in the control group (P < 0.05). Among 62 pregnant women suspected of having fetal distress, 21 were positive and 41 were negative. There were 14 true positive cases and 26 true negative cases of MCA. Fetal UmA was diagnosed in 13 true positive cases and 28 true negative cases. There were 13 true positive cases and 23 true negative cases of UtA in pregnant women. There were 20 true positive cases and 38 true negative cases. The sensitivity, specificity and accuracy of combined diagnosis were 95.24% (20/21), 92.68% (38/41) and 93.55% (58/62), compared with 66.67% (14/21), 63.41% (26/41), 64.52% (40/62) and 61.90% (1) for fetal UmA diagnosis The diagnosis of UtA in pregnant women was 61.90% (13/21), 56.10% (23/41), 58.06% (36/62) high (P < 0.05). Conclusion When fetal distress occurs, fetal UmA, MCA blood flow and maternal UtA blood flow will show significant changes. Ultrasound can detect the changes of the above indicators, and improve the sensitivity and accuracy of the diagnosis of fetal distress.