Implantation represents the limiting step in governing reproductive outcomes. The process is driven by both embryo and endometrium alike. Minute perturbations in this orchestration lay foundation for pregnancy-associated complications that may manifest throughout the gestational course. Furthermore, placental function dictates many aspects of fetal development inclusive of preeclampsia and intrauterine growth restriction (IUGR). Novel techniques such as Multigate Spectral Doppler Analysis (MSDA) may allow for early detection and diagnosis of potentially deleterious fetal outcomes.