This chapter addresses the clinical evidence that complications in the second half of gestation are manifestations of dysfunctional formation of the placenta in early pregnancy. The major ultrasonic measure of fetal growth in early pregnancy is the crown-rump length (CRL), which is conceptually self-explanatory and technically described. A number of studies have addressed ultrasonic assessment of the placenta in the first trimester and the two main approaches have been three-dimensional ultrasound to estimate placental volume and Doppler flow velocimetry to assess resistance in the uterine circulation. First trimester maternal serum levels of pregnancy-associated plasma protein A (PAPP-A) have been widely studied in the assessment of Down's syndrome risk. A number of studies have directly compared the screening performance of combining ultrasonic and biochemical measurements. Understanding the nature of the common determinants of pregnancy complications and cardiovascular disease may reveal insights into the pathophysiology and prevention of both.