Role of First-Trimester Ophthalmic Artery Doppler in Predicting Preeclampsia and Progression to Eclampsia: A Case Series

Abstract

Background: Preeclampsia is a leading cause of maternal and perinatal morbidity, and its cerebral complication, eclampsia, contributes substantially to adverse outcomes. The ophthalmic artery offers an accessible window into the cerebral circulation, but first-trimester data remain limited. We evaluated first-trimester ophthalmic artery Doppler for early prediction of preeclampsia and eclampsia.

Case presentation: In this prospective observational case series, ten pregnant women aged 28–36 years underwent ophthalmic artery Doppler at 11⁺⁰–13⁺⁶ weeks. Resistance index (RI), pulsatility index (PI), the second-to-first peak systolic velocity ratio (PSV ratio, P2/P1) and second peak systolic velocity (PSV2) were recorded, and participants were followed for disease development. Given the small sample, findings are reported descriptively.

Results: Seven women subsequently developed eclampsia and three remained normotensive. Those who progressed consistently showed reduced RI (mostly <0.60) and PI (≤1.1) with an elevated PSV ratio (>0.65) and PSV2 (≥43.75 cm/s, reaching 50.5 cm/s), whereas unaffected women retained higher impedance and lower velocities. The PSV ratio was the most discriminating index, exceeding 0.65 in every affected woman.

Conclusion: A first-trimester ophthalmic artery Doppler signature of low orbital vascular impedance and high systolic velocity preceded eclampsia in this series. Although limited by sample size, these findings suggest early orbital Doppler merits further evaluation as a simple, non-invasive screening tool for preeclampsia and eclampsia.