Background:Many screening tests are available for predicting adverse pregnancy outcome and these range from non- invasive to invasive and serum alpha-fetoprotein level estimation is one of them. The present study was conducted to assess association between second trimester maternal serum alpha-fetoprotein in 14-22 weeks and adverse pregnancy outcome. Materials & Methods: 250 patients of gestational age between 14-22 weeks were included. Maternal serum alpha-fetoprotein was measured in human serum by microplateimmunoenzymometric assay by EIA-AFP kit. Maternal serum alpha-feto protein level was expressed in IU/ml. Results: 23 (9.2%) participants out of 250 developed preterm labor. 21 out of 23 had raised value of maternal serum alpha-fetoprotein. 20 (8%) patients out of 250 patients developed oligohydramnios. 13 out of 20 had raised value of maternal serum alpha-fetoprotein. 14 (5.6%) patients out of 250 developed pre-eclampsia, 11 out of 14 had raised values of maternal serum alpha-fetoprotein. 7 (2.8%) patients out of 250 developed premature rupture of membrane (PROM). 4 out of 7 had raised values of maternal serum alphafetoprotein. Conclusion: There is an increased risk of pre-eclampsia, preterm delivery, oligohydramnios and premature rupture of membrane with elevated maternal serum alpha-fetoprotein levels.