Objective: To evaluate and compare the role of uterine artery diastolic notch in Colour Doppler USG with Roll over test in prediction of Preeclampsia in high risk women.Methods:Colour flow pulsed Doppler imaging of both uterine arteries in between 20–24 weeks was performed on 183 high risk antenatal women. The same women were then subjected to Roll over test in between 28–32weeks of gestation. Results:The primary outcome was uterine artery diastolic notching showed a higher specificity (98.17%) and positive predictive value (95.12%) than roll over test (specificity 68.81%, positive predictive value 53.42%). Kappa analysis showed moderate agreement for colour Doppler study whereas poor agreement for roll over test.74(40%) patients developed Preeclampsia. The rate of pregnancy complications, preterm delivery, LBW babies, APGAR score <7,duration of stay in NICU was significantly lower in group with controlled BP and earlier diagnosis of Preeclampsia . Conclusion:The persistence of diastolic notch in Doppler study is a better screening test than Roll over test in early prediction & management of pre eclampsia