OBJECTIVE: The study's aim was to perform serial placental biometry and Doppler assessments in antenatal women and compare the characteristics of preeclampsia (PE) and normal outcome. METHODS: This prospective cohort study was carried out after ethical clearance. Placental length (PL), thickness, and plavental volume (PV), along with the uterine artery (Ut), middle cerebral artery (MCA), and umbilical artery (UA) blood flow were evaluated serially at 11-14, 20-24, and 28-32 weeks of gestation. The women were followed until delivery, those with PE were considered cases, and those with no other adverse outcome were controls. The placental attributes between cases and controls were compared. RESULTS: A total of 135/1008 (13.4%) had hypertensive disorders of pregnancy (HDP) and 44/1008 (4.4%) had PE, and no maternal or fetal adverse outcomes were seen in 600 (59.5%) women. The PL and PV were significantly less in those with PE (P = 0.005) than in controls. The ratios of PL/Ut A PI and PV/Ut A PI were significantly lower in cases than in controls in all trimesters (P <
0.001). In the first trimester, the area under the curve (AUC), sensitivity, and specificity of PV/Ut A PI for PE prediction were 0.801, 81.8%, and 70.5%, respectively. The sensitivity and specificity of the PL/Ut PI ratio was 81.8% and 70.5%, whereas that at 28-32 weeks was 73.3% & 70.7%. CONCLUSION: Placental parameters were significantly lower in PE than in normal outcome, and the ratios of PL/Ut A PI and PV/Ut A PI proved to be promising markers.