Predictive value of second-trimester ophthalmic artery Doppler for identifying women at risk for preeclampsia

Abstract

BACKGROUND

Preeclampsia (PE) is a multifactorial hypertensive disorder specific to pregnancy that significantly contributes to maternal and perinatal morbidity and mortality worldwide. According to hospital-based studies, its prevalence in India ranges from 5% to 15%. Despite advances in obstetric care, the early identification of women at risk remains a major clinical challenge. Ophthalmic artery Doppler (OAD), a noninvasive and reproducible imaging technique, provides important information on cerebral autoregulation and maternal vascular resistance with potential exploratory utility in the early detection of PE.

AIM

To evaluate the predictive value of maternal OAD indices measured during the second trimester (17–23 weeks of gestation) for the subsequent development of PE in a cohort of initially normotensive pregnant women.

METHODS

This prospective observational study, conducted from March 2024 to February 2025, enrolled 90 antenatal women in their second trimester with no prior history of hypertension or renal disease. OAD evaluation was performed using the transorbital approach with the Alpinion E-CUBE 8 ultrasound system, and key Doppler indices were recorded. Participants were subsequently followed through the third trimester to assess the development of PE. Statistical analysis was performed using the independent samples t-test for continuous variables, Fisher’s exact test for categorical variables, and receiver operating characteristic curve analysis to assess the predictive performance of Doppler parameters.

RESULTS

Out of the 90 participants, 8 (8.89%) developed PE during follow-up. The resistive index (P = 0.004), pulsatility index (P = 0.0003), and most notably, the peak ratio (PR) (P < 0.0001) showed statistically significant differences between the normotensive and preeclamptic groups. Among the Doppler parameters, PR demonstrated the best diagnostic performance, with a diagnostic accuracy of 91.11%, sensitivity of 100%, specificity of 90.24%, and area under the receiver operating characteristic curve of 0.90. Elevated PR values were strongly associated with the subsequent development of PE, indicating potential predictive value that requires further validation in larger studies.

CONCLUSION

Maternal OAD measurements, particularly PR, demonstrated significant associations with the subsequent development of PE in this study cohort. Its noninvasive nature, ease of application, and observed diagnostic performance suggest that it may warrant further evaluation as an adjunctive risk stratification tool in antenatal screening protocols, particularly in resource-limited settings. The early detection and management of high-risk pregnancies could be greatly improved by incorporating OAD into standard obstetric care, potentially improving maternal and perinatal outcomes.

Keywords: Preeclampsia; Ophthalmic artery Doppler; Peak ratio; Pulsatility index; Resistive index; Maternal cerebral hemodynamics; Antenatal screening

Core Tip: Preeclampsia is a leading cause of maternal and neonatal morbidity in India, with a prevalence of 5%–15%. The ophthalmic artery reflects cerebral hemodynamic changes during pregnancy, and ophthalmic artery Doppler offers a noninvasive method to assess maternal vascular resistance. In this prospective study, transorbital ophthalmic artery Doppler was performed to assess 90 normotensive antenatal women during the second trimester. Doppler parameters were recorded, and participants were followed through the third trimester to monitor the subsequent development of preeclampsia.