The utility of the roll-over test (ROT) as a prognostic tool for predicting pregnancy-induced hypertension (PIH) was examined in primiparas in Quito, Ecuador. In Study I, 14 of 16 subjects with a +ROT developed PIH (positive predictive value (PPV) = 88%); only 2 of 27 subjects with a -ROT developed PIH (negative predictive value (NPV) = 92.5%). In Study II (n = 66), the PPV and NPV were 71.4% and 78.6%, respectively. Data from these and previous studies indicate that although the ROT is not a perfect predictor, its advantages recommend usage in populations with high PIH-associated maternal and perinatal mortality.