Doppler Ultrasound in Preeclampsia and Eclampsia: Predicting Complications and Guiding Management

Abstract

Background: Preeclampsia remains a significant cause of maternal and fetal morbidity and mortality worldwide. Early prediction and appropriate management are essential for improving outcomes.

Objective: To evaluate the role of Doppler ultrasound indices of uterine, umbilical, and middle cerebral arteries in predicting adverse maternal and perinatal outcomes in patients with preeclampsia.

Methods: This prospective observational study included 60 pregnant women diagnosed with preeclampsia at 24-34 weeks of gestation. All patients underwent Doppler ultrasound evaluation of uterine arteries (UtA), umbilical artery (UA), and middle cerebral artery (MCA). Patients were followed until delivery and postpartum period. Primary outcomes included gestational age at delivery, mode of delivery, birth weight, APGAR scores, NICU admission, and maternal complications.

Results: Abnormal Doppler indices were significantly associated with adverse perinatal outcomes. Elevated uterine artery mean pulsatility index (PI) >1.45 had a sensitivity of 82.6% and specificity of 89.2% in predicting adverse outcomes. Umbilical artery PI >1.35 demonstrated 78.3% sensitivity and 83.8% specificity. The cerebroplacental ratio (CPR) <1.0 showed the highest sensitivity (91.3%) in predicting adverse outcomes. Absent or reversed end-diastolic flow in the umbilical artery was associated with 100% NICU admission rate and significantly higher perinatal mortality (66.7%).

Conclusion: Doppler ultrasound evaluation provides valuable information for predicting complications and guiding management in preeclampsia. The cerebroplacental ratio emerged as the most sensitive predictor of adverse perinatal outcomes, while absent/reversed end-diastolic flow indicated the highest risk for perinatal mortality.