【】Objective? Exploring the value of ultrasound microvascular imaging (SMI) in evaluating placental perfusion levels and predicting adverse pregnancy outcomes in patients with gestational hypertension disorder (HDCP). Methods? A total of 103 pregnant women diagnosed with HDCP in Kunming Maternal and Child Health Hospital were selected as the HDCP group, and 105 pregnant women with normal blood pressure during the same period were selected as the control group. SMI examination was performed between the two groups, and placental blood perfusion parameters and the incidence of adverse pregnancy outcomes were compared. Patients in HDCP group were divided into simple hypertension group, mild preeclampsia group and severe preeclampsia group according to the severity of the disease, and the value of perfusion indexes in predicting adverse pregnancy outcomes was analyzed by receiver operating characteristic curve (ROC).? Results The values of uterine artery PI, S/D and RI in the HDCP group were higher than those in the control group, and the values of placental VI in the HDCP group were lower than those in the control group, and the above indexes were statistically significant (P<0.05). The PI, S/D and RI values of umbilical artery in HDCP group were higher than those in control group, and the differences were statistically significant (P<0.05). The values of uterine artery PI, S/D and RI in patients with simple pregnancy hypertension, mild preeclampsia and severe preeclampsia gradually increased, while the values of placenta VI gradually decreased. Pin-two comparison of the above indexes among all groups showed significant differences (P<0.05). The PI, S/D and RI values of umbilical artery were gradually increased in patients with simple pregnancy hypertension, mild preeclampsia and severe preeclampsia, and the above indexes were statistically significant among all groups (P<0.05). The incidence of preterm delivery, cesarean section, neonatal asphyxia, fetal growth restriction and fetal distress in HDCP group were higher than those in control group, and the above indexes were statistically significant (P<0.05). The area AUC values of uterine artery PI, S/D, RI, placenta VI and the combined application of the four to predict adverse pregnancy outcomes in HDCP pregnant women were 0.654, 0.576, 0.671, 0.762 and 0.884, respectively. The area AUC values of umbilical artery PI, S/D, RI, placenta VI and the combination of the four to predict adverse pregnancy outcomes in HDCP pregnant women were 0.700, 0.712, 0.779, 0.762 and 0930, respectively. Conclusion Evaluating uterine artery and umbilical artery blood flow parameters and placental perfusion levels in HDCP patients through SMI technology can effectively assess the condition of gestational hypertension and has high predictive value for adverse pregnancy outcomes in HDCP pregnant women.