Our objective was to evaluate the predictive value of uterine artery Doppler flow velocimetry with regard to a serious risk of adverse perinatal outcome in growth-retarded fetuses. A prospective comparative study of pregnancies complicated with growth-retarded fetus with normal and abnormal uterine artery blood flow was performed. Ninety-three pregnancies were assessed by Doppler flow velocimetry in terms of the resistance index at 27-36 weeks. The relative risks (95% Confidence Interval) in 52 pregnancies with abnormal uterine artery blood flow compared with 41 pregnancies with normal uterine artery blood flow were as follows: Premature delivery: 2.29 (1.32-3.97), birth weight < 2,000g: 2.94 (1.74-4.97), cesarean section for fetal distress: 2.57 (1.30-5.05), admission to NICU: 3.27 (1.60-6.69). The findings in this study suggest that abnormal uterine artery blood flow is associated with a serious risk of adverse perinatal outcome in a pregnancy complicated with a growth-retarded fetus. Doppler flow velocimetry of the maternal uterine artery is useful for determining the clinical management of a pregnancy complicated with a growth-retarded fetus.