A prospective study evaluated sonographic second-trimester placental volume measurements in the prediction of fetal outcome. A parallel section scan method was used. Abnormal fetal outcome could be predicted with a sensitivity and specificity of approximately 90%. Evidence is given that fetal growth retardation is preceded by abnormal placental development in the first half of pregnancy. To a large extent, fetal birth weight and outcome are results of placental development and the ability of the placenta to meet the growing needs of the fetus as determined by its intrinsic growth potential.