Recent evidence suggests a strong benefit from low-dose aspirin initiated in women with abnormal first-trimester pre-eclampsia screening including uterine artery pulsatility index (UtA-PI). First-trimester UtA-PI shows moderate intra/ inter-observer reproducibility using the sagittal approach. The purpose of this study was to evaluate the potential use of a novel approach (Transverse technique). Specifically, we describe/compare the transverse versus sagittal approach to determine differences, if any, in 1) time required for a satisfactory image, 2) the measurement indices (PI), and 3) the subjective difficulty of the technique. We conducted a prospective study of 40 women with singleton pregnancies between 11-13+6 weeks of gestation. Consecutive bilateral measurements of the ascending branch of the UtAs were performed using the 2 techniques (transverse and sagittal in random order) by 4 sonographers (10 cases each). The measurement indices (PI), time required for each measurement and the subjective difficulty to obtain a satisfactory measurement were compared. Wilcoxon rank sign and Student's paired t tests were used when appropriate. Cumulative summation (CUSUM) target charts were generated to assess central tendency and dispersion. We observed no difference in mean UtA-PI values between the sagittal (1.47; 95% CI 1.33-1.61) and transverse (1.52; 95% CI 1.38-1.66) techniques (p=0.17), nor in the mean time to acquire satisfactory measurements (Sagittal: 184s vs Transverse: 177s, p=0.80). However, the 4 sonographers estimated that the transverse technique was easier to perform (p=0.04). Moreover, the transverse technique matched the expected distribution (central tendency/dispersion) better than the sagittal technique according to CUSUM. This novel transverse approach for the measurement of UtA-PI in the first-trimester appears very promising, and could potentially help in the broad implementation of first trimester pre-eclampsia screening. Studies to further assess its' reproducibility and precision are underway.