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Objective: To investigate the diagnostic value of MCA/UA pulsatility index ratio for the prediction of adverse perinatal outcome in the fetuses with preeclampsia and gestational hypertension. Materials and methods: We included in the study 738 patients recovered in our Hospital with the diagnosis of preeclampsia and gestational hypertension, from January 2006 to December 2009. All the patients underwent accurate color Doppler velocimetry examination. The study population was divided into two groups depending on the normal or abnormal values of MCA/UA pulsatility index ratio. Outcome variables were intrauterine and early neonatal death, admission to the neonatal intensive care unit and the duration of treatment, Apgar score below 7 at 5 minutes,cesarean delivery for fetal distress, gestational age at delivery, neonatal birth weight, IUGR. Results: We divided the study population into two groups depending on normal or abnormal value of MCA/UA pulsatility index ratio. In 314 patients we found abnormal values of MCA/UA pulsatility index ratio. Neonates of mothers with abnormal values of MCA/UA pulsatility index ratio had significantly lower gestational age at delivery (34.8 versus 38.4, P<0.0001), lower birth weight (2174.6 g versus 3215.0g, P<0.001), significantly greater risk for perinatal death (30.8% versus 0.23%, P<0.0001) significantly greater risk of admission to intensive care unit (77.8% versus 47.4%, P<0.0001), longer duration of treatment in NICU (10.6 days versus 6.5 days, P<0.0001), greater rate of cesarean delivery for fetal distress (76.7% versus 62.5%,P<0.0001), a great number of neonates with low Apgar score at 5 minute (61.9% versus 22.4%, P<0.0001) greater rate of cesarean delivery for fetal distress(71.9% versus 62.5%,P<0.0001), a great number of fetuses IUGR (7.18% versus 1.76%,P<0.0001). Conclusion: ACM/UA pulsatility index ratio is a very good predictor of adverse outcome in the fetuses with preeclampsia and gestational hypertension.