Senior Consultant, Fetal Medicine, Artemis Hospitals, Gurgaon, India
Part 5 of 7 in Diagnostic Utility of First Trimester Ultrasound
Preeclampsia Screening: Uterine Artery Doppler, PLGF, and the New Role of the Ophthalmic Artery
June 21, 2026
The first trimester is a valuable window for predicting preeclampsia, because it coincides with placental implantation and spiral artery remodelling. Combining maternal history, mean arterial pressure and uterine artery pulsatility index with PAPP-A gives a 62% detection rate for early preeclampsia (72% at a 5% false positive rate); replacing PAPP-A with the newer marker PLGF alongside mean arterial pressure and uterine artery PI pushes detection as high as 90%.
The FMF has recently highlighted ophthalmic artery Doppler as an additional marker: as preeclampsia develops, resistance in the mother's ophthalmic artery tends to fall and velocity rises, with the ratio of second-to-first peak systolic velocity higher in women who go on to develop the condition, most strongly demonstrated at 35-37 weeks. At Artemis, this is performed routinely at 11-13 weeks alongside maternal risk factors and uterine artery PI, with a risk cutoff of 1:200 determining whether daily 150mg aspirin (taken at bedtime) is started.
This guide is based on a live Jivo Masterclass — Dr. Aanchal Sablok taught doctors across Africa on June 21, 2026.
FROM THE LIVE Q&A
How does the stage of CKD (chronic kidney disease) affect the risk of preeclampsia?
Dr. Aanchal Sablok
If the mother already has chronic kidney disease, she is already at risk of chronic hypertension. When placental implantation occurs on top of this background, the relevant terminology is preeclampsia superimposed on chronic hypertension. This represents an even higher risk of developing preeclampsia, particularly in the presence of chronic renal disease, chronic hypertension, or other conditions such as autoimmune disease. The risk of fetal growth restriction (small for gestational age) is also correspondingly higher in this group.
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Frequently Asked Questions
Why is the first trimester a particularly useful window for predicting preeclampsia?▼
The first trimester coincides with placental implantation and spiral artery remodelling, the physiological processes that underlie preeclampsia, making it a valuable window for risk prediction.
How much does PLGF improve preeclampsia detection compared to PAPP-A?▼
Combining maternal history, mean arterial pressure and uterine artery pulsatility index with PAPP-A gives a 62% detection rate for early preeclampsia (72% at a 5% false positive rate). Replacing PAPP-A with the newer marker PLGF alongside mean arterial pressure and uterine artery PI pushes detection as high as 90%.
What is the emerging role of ophthalmic artery Doppler in preeclampsia screening?▼
As preeclampsia develops, resistance in the mother's ophthalmic artery tends to fall while velocity rises. The ratio of second to first peak systolic velocity is higher in women who go on to develop the condition, an effect most strongly demonstrated at 35 to 37 weeks.
What risk threshold determines whether aspirin is started, and at what dose?▼
A risk cutoff of 1:200 determines whether daily 150mg aspirin, taken at bedtime, is started.
When is this preeclampsia screening protocol performed?▼
It is performed routinely at 11 to 13 weeks, alongside assessment of maternal risk factors and uterine artery PI.
In This Series: Diagnostic Utility of First Trimester Ultrasound
- 1.Diagnostic Utility of First Trimester Ultrasound
- 2.Screening for Down Syndrome: How Detection Rates Evolved From 30% to 96%
- 3.Nuchal Translucency: Why a High Reading Doesn't Mean What Patients Fear
- 4.Structural Abnormalities the First-Trimester Scan Can Already Catch
- 5.Preeclampsia Screening: Uterine Artery Doppler, PLGF, and the New Role of the Ophthalmic Artery
- 6.Predicting Preterm Labour: Why Cervical Length Should Be Measured at 12 Weeks
- 7.The Inverted Pyramid of Care: Rethinking When Pregnant Women Should Be Seen