Umbilical venous blood flow could be considered a direct and physiological measurement of vascular placental function, representing the quantity of oxygen and nutrients reaching the fetus. The advent of high-technology ultrasound and pulsed Doppler has overcome some of the limitations of early studies. Indeed, Doppler measurement of umbilical venous blood flow has been found to be accurate when compared with several gold standards for in-vivo flow calculation. Nevertheless, small errors in volume flow components, the vessel area and the mean velocity, result in large errors in the calculation of volume flow. Therefore, technique standardization is of paramount importance. Validation studies in animal models have demonstrated accurate venous blood flow measurements by estimating the vessel's cross-sectional area from perpendicular views of longitudinal sections of free-floating portions of the cord. On the other hand, estimation of the mean velocity from the maximum velocity, rather than using the intensity-weighted mean velocity, is less software-dependent and more clearly defined, yielding estimates with more predictable and systematic errors. By adhering to stringent methodological recommendations, umbilical venous blood flow calculation has moderate to good intra- and interobserver reproducibility. Having been found to be accurate and reproducible, further studies are required to establish the clinical value of umbilical vein flow measurement. Copyright © 2008 ISUOG. Published by John Wiley & Sons, Ltd.