Objective To investigate the relationship between adiponectin combined with the ultrasound blood flow index of the umbilical artery and perinatal outcome in women with severe preeclampsia. Methods Placental tissues were obtained from normal term pregnancies (control group, n=50) and severe preeclampsia patients (PE group, n=50) in Third Affiliated Hospital of Zhengzhou University from February 2014 to October 2014. The expression of adiponectin was examined using immunohistochemical methods and real-time polymerase chain reaction. The umbilical artery was measured by color Doppler, and the umbilical artery systolic/diastolic ratio (UA-S/D), umbilical artery resistance index (UA-RI) and umbilical artery pulsatility index (UA-PI) were determined. The relationship between the expression of adiponectin in placental tissues, UA-S/D and perinatal outcome were analyzed. The data were analyzed using two dependent-sample t test, the log-rank test and Spearman correlation analysis. Results Compared with the control group, infants in the PE group had lower birth weight and placental weight, shorter height, and greater umbilical artery indices including UA-S/D, UA-RI and UA-PI (all P<0.05). The expression of adiponectin and its mRNA in placentae of the PE group was significantly higher than that of the control group (adiponectin: 0.326±0.011 vs. 0.116±0.011, t=99.144, P=0.000;mRNA:4.18±1.80 vs. 1.00±0.51, t=11.985, P=0.000). UA-S/D had a negative correlation with birth weight, onset gestational age and gestational age at birth (r= - 0.897, - 0.469 and - 0.524, all P<0.01). The expression of adiponectin mRNA had a negative correlation with birth weight, onset gestational age, and gestational age at birth (r=-0.580,-0.407 and-0.449, all P<0.01). The expression level of adiponectin had positive correlations with body mass index of the mothers and the UA-S/D (r=0.261 and 0.788, both P<0.01). Conclusions The expression of adiponectin in placental tissues and blood flow index of the umbilical artery both increase in severe preeclampsia, and are associated with poor perinatal outcome.