Most pregnancies, labours, and deliveries are normal biological processes that result in a healthy outcome for mothers and babies. Those that are not normal, however, can result in maternal and/or perinatal mortality or substantial morbidity. In the latest Centre for Maternal and Child Enquiries (CEMACE) report on maternal deaths (“Saving Mothers’ Lives” 2006–2008), preeclampsia/eclampsia was the second commonest cause of direct maternal deaths in the United Kingdom (0.83 per 100,000 maternities). Preeclampsia and fetal growth restriction (FGR) have also been identified as antecedent causes in 6% and 10% of perinatal deaths, respectively. Modern antenatal care provision is focused on a risk-based approach to monitoring for adverse pregnancy outcomes such as preeclampsia, fetal growth restriction, placental abruption, and stillbirth. Increasingly, research is geared toward early identification of risks, thereby allowing early commencement of management strategies to minimise the risk of adverse outcome, including facilitation of an appropriate level of pregnancy monitoring. In this review, the technique of uterine artery Doppler interrogation in the first trimester is outlined, and its role in the prediction of pregnancy complications is discussed