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Summary. Uterine artery flow velocity waveforms (FVW) were obtained prospectively by continuous wave Doppler at 18–22 weeks gestation from 98 women with an unexplained elevation in maternal serum alpha-fetoprotein (MSAFP). A notch in either the left or right uterine artery FVW was present in 18 pregnancies of which seven resulted in perinatal death and six in the birth of very immature and/or severely growth retarded babies. Conversely, in 66 of 80 pregnancies the absence of a notch was associated with the livebirth of an infant beyond 32 weeks gestation, with a birthweight above the 5th centile. It is suggested that the presence of a notch in the uterine artery FVW is a good predictor of poor perinatal outcome.