Prospective case-control study on maternal ophthalmic artery doppler velocimetry in evaluation of pre-eclampsia

Abstract

BACKGROUND AND OBJECTIVE Preeclampsia (PE) is a lethal hypertensive disorder that significantly contributes to maternal as well as fetal morbidity besides mortality, especially in low-resource settings like in India. Early diagnosis and management are crucial in preventing adverse maternal and fetal outcomes. Preeclampsia causes cerebrovascular endothelial dysfunction and impairs cerebral autoregulation due to systemic hypertension. So, monitoring cerebrovascular alterations is crucial for preventing severe neurological complications. In this study, we have used maternal ophthalmic artery Doppler (OAD) as a key tool for monitoring hemodynamic parameters and severity of the disease in preeclampsia and normotensive pregnant women METHODOLOGY A prospective observational case-control study took place in a medical facility that provided tertiary care from April 2023 to March 2025, including 170 pregnant women (85 preeclampsia cases and 85 normotensive controls). OAD metrics, such as pulsatility index (PI), resistivity index (RI), peak systolic velocity (PSV), and end-diastolic velocity (EDV), were measured using high- resolution ultrasound with a 7-10MHz transducer. Data were analysed using SPSS version 20, and cutoff values for determining preeclampsia severity were determined using ROC curve analysis. RESULTS Preeclampsia patients demonstrated significantly higher RI and PI values compared to controls(p=0.001). ROC analysis identified RI >0.72 and a strong predictor of preeclampsia severity (sensitivity 82.3%, Specificity 79.4%). Increased ophthalmic artery Doppler indices correlated with adverse maternal and fetal consequences, including intrauterine growth restriction (IUGR) as well as preterm birth. CONCLUSION This prospective observational case-control study demonstrates the maternal ophthalmic artery doppler velocimetry as a valuable tool in evaluating and predicting preeclampsia in pregnancy. Increased resistance in the right ophthalmic artery and lower pulsatility suggest cerebrovascular dysfunction and impaired autoregulation in pre-eclampsia. As it serves as a promising surrogate marker for cerebrovascular dysfunction, its integration into routine obstetric evaluation may aid in early detection and risk stratification.