To determine associations between normal and abnormal values for the venous ductus pulsatility index (DVIP) with adverse maternal and perinatal outcomes. Retrospective cohort study that included pregnant women underwent screening first trimester ultrasound between 2018 to 2021. We included patients in first trimester gestation with a Crown–rump length (CRL) measurement between 45 and 84 mm and those with availability of screening ultrasound data and clinical data of perinatal outcomes at birth. We excluded multiple or heterotopic pregnancies, the presence of ultrasound structural anomalies, suspected chromosomal anomalies and pregnancies resulting from in vitro conception or assisted reproduction techniques. Sociodemographic data, ultrasound information and maternal and perinatal outcomes were retrieved for the patient's medical records. Reference values for normal DVIP were between 0.68 and 1.24. Statistical analysis was performed considering significant associations (p < 0.05). 1620 women were taken to first trimester screening study of which 722 met inclusion criteria. 424 pregnancies without adverse outcomes and 298 pregnancies with an adverse outcome. 89%, 6,5%, 4.5% had normal, high and low DVIP. Statistically significant differences were found between the patients who presented elevated DVIP and miscarriage (p < 0.01) and pre-eclampsia (P < 0.011). Low DVIP values were associated with congenital heart disease (p < 0.01), neonatal coagulopathy (p < 0.01) and chromosomal abnormality (p 0.014). Finally, combined analysis about adverse maternal-perinatal outcomes did not have statistically significant causal associations. Although DVIP is a measurement used in first trimester screening, we did not find statistically significant causal associations between abnormal DVIP and adverse maternal-perinatal outcomes.