Transcranial Doppler in Preeclampsia and Its Complications.

Preeclampsia is a complex multisystem disorder of pregnancy, and neurological complications are among the most severe outcomes, including eclampsia, cerebrovascular accidents, and altered cerebral perfusion. Understanding cerebral hemodynamics in preeclampsia is essential for early identification of high-risk patients and timely intervention. Transcranial Doppler (TCD) provides real-time, non-invasive measurements of cerebral blood flow velocities and derived indices, which reflect cerebral autoregulation, vascular resistance, and perfusion pressure. These parameters allow detection of pathophysiological changes such as cerebral hypoperfusion, hyperemia, vasospasm, or elevated intracranial pressure, which are relevant for the management of preeclampsia. This study is designed as a prospective, observational, case-control investigation to evaluate the diagnostic and prognostic value of TCD in preeclamptic women. It will be conducted over six months at the Maternity and Neonatology Center of Tunis, including the Departments of Anesthesia, Intensive Care, and Gynecology-Obstetrics (A-D). Eligible participants are women in their third trimester of pregnancy. Women with preexisting conditions affecting cerebral hemodynamics, chronic hypertension, renal, cardiac, hepatic, hematologic disease, COPD, or severe anemia will be excluded. Participants will undergo TCD using a 2 MHz pulsed Doppler probe via the temporal window, primarily assessing the middle cerebral artery. In preeclamptic patients, serial TCD measurements will be performed to monitor changes before and after antihypertensive therapy, magnesium sulfate administration (if indicated), and any clinical complications. Normotensive control patients will undergo a single TCD assessment. Measured parameters include systolic, diastolic, and mean velocities, as well as resistance and pulsatility indices, cerebral perfusion pressure, cerebral flow index, and Lindegaard index. Data analysis will focus on identifying hemodynamic patterns associated with increased cerebral risk, and correlating TCD findings with clinical outcomes and therapeutic interventions. This approach aims to evaluate whether TCD can serve as a reliable, non-invasive tool to stratify risk and guide management in preeclamptic women. The study will contribute to understanding cerebrovascular physiology in preeclampsia and may provide evidence to support the integration of TCD into routine monitoring of high-risk pregnancies, potentially improving maternal and fetal outcomes.