Objectives: To clarify whether microvascular ultrasound Doppler (SMI: superb microvascular imaging) can detect antenatal histological findings in pathologic placentas. Methods: In this prospective diagnostic observational study (STROBE), pregnant women who were admitted to our perinatal center for perinatal management were enrolled. Ultrasound examinations to identify placental pathologies using SMI were performed before delivery. After delivery, the placental tissue was clipped for microscopic examination, as the location of the placenta obtained ultrasound findings. The accuracy of antenatal ultrasound detection of placental pathologies was compared between women who were admitted due to fetal growth restriction (FGR), pre-eclampsia, and other indications. Results: The highest accuracy was observed with placental infarction in FGR (positive predictive value [PPV], 100%; sensitivity, 89%; area under the curve [AUC], 0.945), whereas PPV, sensitivity, and AUC in cases of preeclampsia were relatively low (AUC 0.540). Additionally, PPV, sensitivity, and AUC for avascular villi were 100%, 57%, and 0.785 in cases with FGR, 67%, 67%, and 0.780 in cases with preeclampsia, and 80%, 80%, and 0.920, respectively. The diagnostic accuracies predictive of congestion of stem villi and chorangiosis were insufficient (AUC<0.700). Conclusions: SMI can accurately detect placental pathologic findings, such as placental infarction and avascular villi. This modality may improve the perinatal management in cases of placental abnormalities.