Objective: To evaluate uterine artery Doppler between 11 and 13⁺⁶ weeks for prediction of preeclampsia. Materials and methods: A descriptive observational study was conducted in a teaching hospital of a tertiary care center. Of 200 women screened, 130 women met eligible criteria and 126 consented for participation in the study. In addition to nuchal translucency and crown-rump length, mean uterine artery pulsatility index (PI) was measured at 11–13⁺⁶ weeks, and women were followed up till delivery to observe the development of preeclampsia, gestational hypertension, and fetal growth restriction (FGR). Categorical variables were analyzed using κ agreement, and p = 0.05 was used to calculate significance. Results: Among 117 women followed till delivery, 12 (10.26%) had mean PI >95% and 105 (89.7%) had normal Doppler. A significantly higher number of women with PI ≥95% had preeclampsia (55.56%) (p < 0.001), and the sensitivity of PI in prediction of preeclampsia was 55.56% with specificity of 93.52%. No association was found between PI and FGR (p = 0.228). This study showed a positive association with p value of 0.008 between uterine artery pulsatility index of >95% and development of combined FGR and preeclampsia in a pregnancy. Conclusion: This study showed a positive association between PI >95% with the development of preeclampsia and FGR in pregnancy complicated by preeclampsia. The predictive accuracy of first trimester uterine artery Doppler using PI with cutoff of >95% has low sensitivity in prediction of preeclampsia (55.56%) and FGR (18.75%) but it has high specificity for prediction of both (93.52% and 91.09% respectively).