Agreement between first-trimester maternal ophthalmic artery Doppler risk assessment and the tradicional uterine artery - based model for preeclampsia screening: a case series

Abstract

Introduction: Preeclampsia (PE) is a complex multisystem syndrome that remains one of the leading causes of maternal and neonatal morbidity and mortality. First-trimester screening is based on algorithms that combine several maternal factors, since the early identification of pregnant women with a high-risk phenotype is essential for the implementation of prophylactic strategies and optimized prenatal care.
Objective: To determine whether preeclampsia risk assessment using maternal ophthalmic artery Doppler (OA PVS ratio) in the first trimester is consistent with the tradicional risk assessment model developed by The Fetal Medicine Foundation (FMF) which is based on the uterine artery pulstaility index (UTA-PI).
Methods: This case series included first-trimester pregnant women evaluated between September 29, 2025 and December 26, 2025, at the Daniele Klaus Fetal Medicine Clinic. PE risk calculations using maternal ophthalmic artery Doppler were compared with the traditional FMF risk calculation based on uterine artery Dopppler (UTA-PI).
Results: Of the 116 patients evaluated during the study period, 37% were classified as high risk by the Algorithm1 (A1 based on UTA-PI) and/or Algorithm (A2, based on OA PVS ratio), while 63% were classified as low risk. Among the high-risk patients, 58.2% were identified exclusively by A1, 37.2% were identified exclusively by A2, and 4.6% were classified as high risk by both algorithms simultaneously.
Conclusion: Maternal ophthalmic artery Doppler showed poor agreement with the uterine artery-based risk calculation for preeclampsia screening. Agreement between the two PE risk assessment methods were observed in only 4,6% of the high risk sample in this case series. Further studies with larger sample sizes and detailed postnatal outcome evaluation are required to better elucidate the predictive performance and clinical relevance of both screening algorithms for preeclampsia.