الفهرس 
Aim of the work
* Anatomy of ophthalmic arteryOnly 14 pages are availabe for public view
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Abstract
Pre-eclampsia (PE) poses a serious challenge to maternal and fetal health. It is associated with hemodynamic changes that may affect the internal carotid/ophthalmic artery circulation with consequent neuro-ophthalmic manifestations. Ophthalmic artery Doppler (OAD) ultrasound is an important tool that can be used to detect hemodynamic changes in PE and monitor its severity.
Pre-eclampsia (PE) is a pregnancy-related hypertensive disorder occurring usually after 20 weeks of gestational age (GA) that may progress to eclampsia, which is the end point of the disease spectrum if left untreated. While hypertensive disorders (chronic or pregnancy-induced) complicate 6%–30% of all pregnancies throughout the world,2 PE and eclampsia remain the most important hypertensive disorders in pregnancy. The incidence of PE ranges from 5% to 10% worldwide.
Many studies have emerged in the last decade trying to use ophthalmic artery Doppler to predict preeclampsia and compare its efficiency to uterine artery Doppler that is considered the most accurate tool used nowadays with promising results of similar sensitivity and specificity.
Some problems have been recognized while reviewing these literatures such as the faulty interpretation of the second systolic peak of ophthalmic artery wave as first diastolic peak that has been corrected recently. We also noticed that most of researchers in this topic recruited women with gestational age more than 20 weeks and almost all of them were exclusively done in South America.
This study aimed to demonstrate the ability of changes in ophthalmic artery Doppler indices to predict the development of preeclampsia.
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To elucidate our results, this prospective observational study was carried out between June 2020 and September 2021 on 120 normotensive pregnant women coming to routine antenatal care in SersEllian general hospital.
Full history was taken especially menstrual history to be correlated with the estimated ultrasound age and if there is a difference of more than one week, Ultrasound-determined gestational age was used.
Also, in every Patient blood pressure measurement was recorded as well as weight and height and body mass index (BMI) was calculated from the formula (BMI = Weight / Height in meter²).
Routine pelvic ultrasound examination (using either Trans abdominal (2-6 MHz) convex probe or Trans vaginal (4-9 MHz) endoluminal probe and right ophthalmic artery Doppler (using linear 5-10 MHz tranducer) were performed using Siemens Acuson X 300 ultrasound machine.
For all the enrolled women coming for routine visits after 20 weeks of gestation, blood pressure measurement and the presence or absence of proteinuria were recorded. All subjects were followed up till termination of pregnancy to document the development of preeclampsia and complications.
By the end of the study the cases were divided into normotensive (the control) group that included 96 women, the mild preeclampsia group included 16 cases and the severe preeclampsia group included 8 women.
The results of the current study can be summarized as follows:
The mean of age, BMI, SBP, DBP at time of scan and gestational age of the studied patients were (24.77±4.27 years, 27.23±3.16 kg/m2, 103.50±8.99 mm Hg, 66.33±8.63 mm Hg and 10.15±2.51 months), respectively.
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PSV, P2 and EDV of Ophthalmic artery were significantly increased among severe group than mild and normotensive groups. Also, peak ratio (p2/p1) of ophthalmic artery was significantly increased among severe and mild preeclampsia than normal group. While, PI and RI of Ophthalmic artery were significantly increased among normal (control) group compared to severe and mild groups (P< 0.001).
There was highly significant difference between the studied groups regarding complications, and most of the studied patients had no complications (P<0.001).
There was significant positive correlation between preeclampsia and Ophthalmic artery PSV (P1), 2nd systolic peak (P2), peak ratio (p2/p1), proteinuria by urinary dipstick and Complications (P<0.05). While, there was significant negative correlation between preeclampsia and PI, RI of Ophthalmic artery and termination of pregnancy, (P<0.05).
There was no significant correlation between preeclampsia and age, gestational age, DBP at time of scan and mode of delivery.
Ophthalmic artery RI, PI, peak ratio (p2/p1) and 2nd systolic peak (P2) had sensitivity of (80.2%, 89.7%, 77.3% and 91.7%) and specificity of (74.9%, 75.12%, 65.8% and 61.7%) at cutoff values >0.77, >1.67, >0.59 and >20.1, respectively in predicting pre-eclampsia.