To study the diagnostic efficacy of thrombologram combined with ultrasonic quantitative parameters in fetal growth restriction (FGR). Methods Fifty pregnant women with FGR admitted to our hospital from July 2021 to May 2023 (FGR group) were collected, and 50 pregnant women of the same age (normal fetal development) were selected as the control group. he thromboelastogram indexes (maximum amplitude (MA), Angle Angle, coagulation time (K), coagulation response time (R)), umbilical artery and middle cerebral artery resistance index (RI), pulsation index (PI), end-systolic/end-diastolic peak value (S/D), cerebroplacental rate (CPR), body weight, abdominal circumference, binary correlation and partial correlation were analyzed between the two groups. The relationship between body weight and abdominal circumference and ultrasonic quantitative parameters were analyzed by ROC, and the value of combined diagnosis of FGR was analyzed. Results The R and K of FGR group were lower than those of control group in the second and third trimester, before delivery, and the Angle and MA were higher than those of control group (P < 0.05). Umbilical artery S/D, umbilical artery PI and umbilical artery RI in FGR group were higher than those in control group during the second and third trimester and before delivery, while middle cerebral artery S/D, middle cerebral artery PI, middle cerebral artery RI and CRP were lower than those in control group (P < 0.05). The weight and abdominal circumference of the FGR group were lower than those of the control group in the second and third trimesters and before delivery (P < 0.05). The bivariate correlation showed that the thrombologram and ultrasound quantitative parameters before delivery were more strongly correlated with body weight and abdominal circumference (P < 0.05). Partial correlation showed that R, K, middle cerebral artery RI and CRP were positively correlated with body weight and abdominal circumference before delivery, while Angle, MA, umbilical artery S/D, umbilical artery PI and umbilical artery RI in FGR group were higher than those in control group during the second and third trimester and before delivery, while middle cerebral artery S/D, middle cerebral artery PI, middle cerebral artery RI and CRP were lower than those in control group (P < 0.05). The weight and abdominal circumference of the FGR group were lower than those of the control group in the second and third trimesters and before delivery (P < 0.05). The bivariate correlation showed that the thrombologram and ultrasound quantitative parameters before delivery were more strongly correlated with body weight and abdominal circumference (P < 0.05). Partial correlation showed that R, K, middle cerebral artery RI and CRP were positively correlated with body weight and abdominal circumference before delivery, while Angle, MA, umbilical artery S/D, umbilical artery PI and umbilical artery RI were still negatively correlated with body weight and abdominal circumference (P < 0.05). The AUC in the diagnosis of FGR combined with thrombologram and quantitative ultrasound parameters was higher than that of each single index (P < 0.05). Conclusion The quantitative detection of thrombologram combined with ultrasound in pregnant women with FGR can effectively monitor the changes of coagulation function and fetal hemodynamics in different periods, which has high value in the combined diagnosis of FGR.