Prospective Observational Case-Control Study on the Potential of Maternal Ophthalmic Artery Doppler Velocimetry in the Evaluation of Preeclampsia

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 India. Thus, it is essential to diagnose and manage early to prevent poor maternal and fetal outcomes. PE causes cerebrovascular endothelial dysfunction and impairs cerebral autoregulation due to systemic hypertension. So, monitoring of cerebrovascular alteration is crucial for preventing severe neurological outcomes. 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 PE 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 PE cases and 85 normotensive controls). OAD metrics, such as pulsatility index (PI), resistivity index (RI), peak systolic velocity, and end-diastolic velocity, were measured using high-resolution ultrasound with a 7-10MHz transducer. Data were analyzed using IBM SPSS Statistics for Windows, Version 20 (Released 2011; IBM Corp., Armonk, New York, United States), and cutoff values for determining PE severity were determined using receiver operating characteristic (ROC) curve analysis. Results PE 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 PE severity (sensitivity 82.3%, specificity 79.4%). Increased OAD indices correlated with adverse maternal and fetal consequences, including intrauterine growth restriction as well as preterm birth. Conclusion This prospective observational case-control study demonstrates the maternal OAD velocimetry as a valuable tool in evaluating and predicting PE in pregnancy. Increased resistance in the right ophthalmic artery and lower pulsatility suggest cerebrovascular dysfunction and impaired autoregulation in PE. 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.