An abnormal result of an umbilical artery Doppler study reflects the presence of placental vascular pathologic mechanisms and identifies pregnancies at increased risk for perinatal mortality. Recent reviews of the clinical utility of umbilical artery Doppler study have concluded that it should not be routinely used as a screening modality for the general obstetric population and have suggested that further research is required. However, metaanalysis of published peer-reviewed and randomized controlled trials indicates that its use in high-risk pregnancies is associated with a significant decrease in perinatal mortality without an increase in the rate of inappropriate obstetric intervention. This clinical opinion serves to underscore the relevance of umbilical artery Doppler velocimetry to clinical practice and to suggest that an abnormal result of an umbilical artery Doppler study should be added to the current list of indications for intensive fetal surveillance.