Background: This study evaluates the utility of second-trimester uterine artery Doppler screening in predicting the risk of preeclampsia (PE) and fetal growth restriction (FGR) and examines its impact on pregnancy outcomes. Methods: A prospective cohort study was conducted involving 100 pregnant women in their second trimester were included, with specific criteria to target those at potential risk for PE and FGR. Uterine artery Doppler screening was performed to measure Pulsatility Index (PI) and Resistance Index (RI). Primary outcomes included the development of PE and FGR, with secondary outcomes assessing intervention effectiveness and neonatal outcomes. Statistical analyses included sensitivity, specificity, positive and negative predictive values, likelihood ratios, and Receiver Operating Characteristic (ROC) curve analysis. Results: Sensitivity for predicting PE was 85%, with a specificity of 48%, positive predictive value (PPV) of 40%, and negative predictive value (NPV) of 91%. For FGR, sensitivity was 71%, specificity was 45%, PPV was 23%, and NPV was 90%. Combined prediction sensitivity was 83%, specificity was 47%, PPV was 48%, and NPV was 86%. Statistical analysis showed significant relationships between Doppler screening and maternal/fetal outcomes (p < 0.00001 for maternal risk factors; p = 0.001653 for fetal outcomes). Among Doppler abnormalities, 36 cases developed hypertensive disorders of pregnancy despite prophylactic aspirin administration. Conclusion: Second-trimester uterine artery Doppler screening demonstrates promising predictive accuracy for PE and FGR. Despite limitations, early detection offers opportunities for intervention in high-risk pregnancies, potentially improving maternal and fetal outcomes. Recommendations: Implementing routine second-trimester uterine artery Doppler screening in clinical practice may enhance risk stratification for PE and FGR, guiding timely interventions to mitigate adverse pregnancy outcomes.