Ultrasound parameters of ophthalmic and renal maternal blood flow at first and second prenatal screening in patients with high and low risk of preeclampsia

Preeclampsia is a severe obstetric complication that leads to adverse pregnancy and delivery outcomes. Existing multifactorial models make it possible to identify high-risk groups for the development of preeclampsia, but the task of improving prediction accuracy remains relevant. Therefore, the search for additional predictors of preeclampsia continues.

Objective. To identify specific features of Doppler indices of blood flow in the interlobar renal arteries and ophthalmic arteries in pregnant women over time (at 11–14 and 19–21 weeks of gestation) in groups with low and high risk of developing preeclampsia, as calculated using the Astraia software.

Materials and Methods. Ultrasound examinations of the maternal ophthalmic and renal arteries were performed during prenatal screening at 11–14 and 19–21 weeks of pregnancy. Next, we compared flow velocity parameters, resistance index, pulsatility index, and the ratio of peak systolic velocities in the ophthalmic arteries, as well as the resistance index in the renal arteries, over time in patients with low and high individual combined risk of preeclampsia.

Results. In the high-risk group, a decrease in blood flow resistance in the ophthalmic artery was observed. In the low-risk group, there was an increase in the resistance index in the renal arteries, an increase in peak systolic velocity in the ophthalmic artery, an increase in the DV/P2 ratio, and a decrease in PR.

Conclusions. In the low-risk group, blood flow parameters changed as pregnancy progressed, probably due to cardiovascular adaptive mechanisms. In the high-risk group, physiological changes in blood flow during pregnancy were nearly absent.  

1. James P.R., Nelson-Piercy C. Management of Hypertension before, during, and after Pregnancy. Heart. 2004; 90 (12): 1499–1504. https://doi.org/10.1136/hrt.2004.035444

2. Clinical practice guidelines “Preeclampsia. Eclampsia. Edema, proteinuria and hypertensive disorders of pregnancy, labor and postnatal period”. https://cr.minzdrav.gov.ru/view-cr/637_2 (2024, accessed 23.02.2025). (In Russian)

3. Kuklina E.V., Ayala C., Callaghan W.M. Hypertensive disorders and severe obstetric morbidity in the United States. Obstet. Gynecol. 2009; 113 (6): 1299–1306. https://doi.org/10.1097/AOG.0b013e3181a45b25

4. Order of the Ministry of Health of the Russian Federation dated 20.10.2020 No. 1130n “On approval of the procedure for providing medical care in the field of Obstetrics and gynecology”, 2020. (In Russian)

5. Clinical practice guidelines “Normal pregnancy”. https://cr.minzdrav.gov.ru/ view-cr/288_2 (2025, accessed 15.03.2025). (In Russian)

6. Orosz L., Orosz G., Veress L. et al. Screening for preeclampsia in the first trimester of pregnancy in routine clinical practice in Hungary. J. Biotechnol. 2019; 300: 11–19. https://doi.org/10.1016/j.jbiotec.2019.04.017

7. Prasad S., Sahota D.S., Vanamail P. et al. Performance of fetal medicine foundation algorithm for first trimester preeclampsia screening in an Indigenous South Asian population. BMC Pregnancy Childbirth. 2021; 21 (1): 1–7. https://doi.org/10.1186/s12884-021-04283-6

8. Cuenca-Gómez D., De Paco Matallana C., Rolle V. et al. Comparison of different methods of first-trimester screening for preterm pre-eclampsia: Cohort Study. Ultrasound Obstet. Gynecol. 2024; 64 (1): 57–64. https://doi.org/10.1002/uog.27622

9. Gana N., Sarno M., Vieira N. et al. Ophthalmic artery doppler at 11–13 weeks’ gestation in prediction of pre-eclampsia. Ultrasound Obstet. Gynecol. 2022; 59 (6): 731–736. https://doi.org/10.1002/uog.24914

10. Kalafat E., Laoreti A., Khalil A. et al. Ophthalmic artery doppler for prediction of pre-eclampsia: systematic review and meta-analysis. Ultrasound Obstet. Gynecol. 2018; 51 (6): 731–737. https://doi.org/10.1002/uog.19002

11. Maryanova T.A., Chechneva M.A., Klimova I.V. et al. Doppler of renal blood flow in renal pathology: chronic kidney disease and preeclampsia. Poliklinika. 2015; 6: 36–39. (In Russian)

12. Shekhtman M.M. Kidney diseases and pregnancy. Moscow: Medicina, 1980. 184 p. (In Russian)

13. Freidin A., Klimkin A., Petrov S. A change in renometric indicators and renal arterial resistive index in pregnancy complicated by preeclampsia. Vrach. 2016; 10: 62–66. (In Russian)

14. Freidin A., Klimkin A., Petrov S. Hemodynamic features of renal blood flow in the first trimester of physiological pregnancy. Trudniy Pacient. 2019; 13 (8–9): 10–11. (In Russian)

15. Verzakova I.V., Setoyan M.A. The examination of the renal blood flow in pregnant women. Bashkortostan Medical Journal. 2008; 5: 54–57. (In Russian)

16. Markovic V.M., Mikovic Z., Djukic M. et al. Doppler parameters of maternal renal blood flow in normal pregnancy. Clin. Exp. Obstet. Gynecol. 2013; 40 (1): 70–73.

17. Sturgiss S.N., Martin K., Whittingham T.A., Davison J.M. Assessment of the renal circulation during pregnancy with color doppler ultrasonography. Am. J. Obstet. Gynecol. 1992; 167 (5): 1250–1254. https://doi.org/10.1016/S0002-9378(11)91696-2

18. Dib F.R., Duarte G., Sala M.M. et al. Prospective evaluation of renal artery resistance and pulsatility indices in normal pregnant women. Ultrasound Obstet. Gynecol. 2003; 22 (5): 515–519. https://doi.org/10.1002/uog.240

19. Nakai A., Asakura H., Oya A. et al. Pulsed Doppler US findings of renal interlobar arteries in pregnancy-induced hypertension. Radiology. 1999; 213: 423–428. https://doi.org/10.1148/radiology.213.2.r99nv18423

20. Di Nicolò P., Granata A. Renal intraparenchymal resistive index: the ultrasonographic answer to many clinical questions. J. Nephrol. 2019; 32 (4): 527–538. https://doi.org/10.1007/s40620-018-00567-x

21. Liberati M., Rotmensch S., Zannolli P., Bellati U. Doppler velocimetry of maternal renal interlobar arteries in pregnancy-induced hypertension. Int. J. Gynaecol. Obstet. 1994; 44 (2): 129–133. https://doi.org/10.1016/0020-7292(94)90066-3

22. Thaler I., Weiner Z., Itskovitz J. Renal artery flow velocity waveforms in normal and hypertensive pregnant women. Am. J. Hypertens. 1992; 5 (6, Pt. 1): 402–405. https://doi.org/10.1093/ajh/5.6.402

23. Shifman E.M., Khramtchenko N.V. The hemodynamics status of ophthalmic arteries and superior opthalmic veines in women. Russian Medicine. 2013; 2: 20–23. (In Russian)

24. Carneiro R.S., Sass N., Diniz A.L. et al. Ophthalmic artery doppler velocimetry in healthy pregnancy. Int. J. Gynecol. Obstet. 2008; 100 (3): 211–215. https://doi.org/10.1016/j.ijgo.2007.09.028

25. Corrêa-Silva E.P., Surita F.G., Barbieri C. et al. Reference values for doppler velocimetry of the ophthalmic and central retinal arteries in low-risk pregnancy. Int. J. Gynecol. Obstet. 2012; 117 (3): 251–256. https://doi.org/10.1016/j.ijgo.2012.01.012

26. de Oliveira C.A., de Sá R.A.M., Velarde L.G.C. et al. Doppler velocimetry of the ophthalmic artery in normal pregnancy. J. Ultrasound Med. 2009; 28: 563–569. https://doi.org/10.7863/jum.2009.28.5.563

27. Gibbone E., Sapantzoglou I., Nuñez-Cerrato M.E. et al. Relationship between ophthalmic artery doppler and maternal cardiovascular function. Ultrasound Obstet. Gynecol. 2021; 57 (5): 733–738. https://doi.org/10.1002/uog.23601

28. Sapantzoglou I., Wright A., Arozena M.G. et al. Ophthalmic artery doppler in combination with other biomarkers in prediction of pre-eclampsia at 19-23 weeks’ gestation. Ultrasound Obstet. Gynecol. 2021; 57 (1): 75–83. https://doi.org/10.1002/uog.23528

29. Praciano de Souza P.C., Gurgel Alves J.A., Bezerra Maia E. et al. Second trimester screening of preeclampsia using maternal characteristics and uterine and ophthalmic artery doppler. Ultraschall. Med. 2018; 39 (2): 190–197. https://doi.org/10.1055/s-0042-104649

30. Aquino L.O. de, Leite H.V., Cabral A.C.V., Brandão A.H.F. Doppler flowmetry of ophthalmic arteries for prediction of pre-eclampsia. Rev. Assoc. Med. Bras. 2014; 60 (6): 538–541. https://doi.org/10.1590/1806-9282.60.06.011