An observational study in Pre Eclampsia, sponsored by University Tunis El Manar. Completed at 1 site in Tunisia. Open to female participants aged 18 Years to 45 Years, including healthy volunteers. Per ClinicalTrials.gov, last updated 2026-06-12.
Sponsored by University Tunis El Manar · Observational
Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality. It is defined by new-onset hypertension after 20 weeks of gestation, often associated with proteinuria and/or systemic complications such as thrombocytopenia, renal impairment, hepatic dysfunction, neurological symptoms, pulmonary edema, or intrauterine growth restriction. Neurological involvement is particularly severe, as it may progress to eclampsia, intracerebral hemorrhage, or ischemic stroke. Detecting early cerebral hemodynamic changes is therefore essential.
Transcranial Doppler (TCD) is a non-invasive ultrasound technique that measures cerebral blood flow velocities, particularly in the middle cerebral artery (MCA). It provides systolic, diastolic, and mean velocity values, and calculates indices such as pulsatility index (PI), resistance index (RI), cerebral perfusion pressure (CPP), resistance area product (RAP), cerebral flow index (CFI), and Lindegaard index (LI). These parameters can detect impaired cerebral autoregulation, hyperemia, vasospasm, or cerebral hypoperfusion. Although several studies suggest that preeclampsia is associated with altered cerebral hemodynamics, the diagnostic and prognostic role of TCD remains insufficiently defined.
The objective of this prospective, observational, case-control study is to evaluate the diagnostic and prognostic value of TCD in preeclampsia and its complications. The study will be conducted at the Maternity and Neonatology Center of Tunis (Departments of Anesthesia, Intensive Care, and Gynecology-Obstetrics A-D) over six months, from January to June 2025.
Participants will be pregnant women in their third trimester, divided into two groups:
Exclusion criteria include chronic hypertension, chronic kidney disease, epilepsy, hematologic disease, cardiac or liver disease, COPD, severe anemia, technical difficulties preventing TCD, loss to follow-up, or diagnostic uncertainty. Women with isolated gestational hypertension will also be excluded.
TCD will be performed via the temporal window using a 2 MHz pulsed Doppler probe, mainly focusing on the MCA. In Group A, measurements will be obtained before and after antihypertensive therapy, before and after magnesium sulfate administration when indicated, and before and after any complications. In Group B, a single TCD will be performed during the third trimester.
The study will compare cerebral blood flow velocities and indices between groups and monitor their evolution over time. Data interpretation will allow classification of findings into patterns such as systemic hypoperfusion, cerebral hypoperfusion with elevated intracranial pressure, hyperemia, or vasospasm.
The expected outcome is to establish whether TCD can serve as a reliable diagnostic and prognostic tool in preeclampsia. The results will contribute to a better understanding of cerebrovascular physiology in this condition and may help identify women at higher risk of neurological or systemic complications. Ultimately, this work aims to highlight TCD as a simple, reproducible, and non-invasive tool for clinical management and risk stratification in preeclampsia.
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.
916 studies on the registry are indexed under Pre-Eclampsia; 243 are open to participants now.
This study's enrollment of 100 is below the median of 165 across 397 observational studies indexed under Pre-Eclampsia.
Browse Pre-Eclampsia studies →University Tunis El Manar is the lead sponsor of 74 studies on the registry; 12 are open to participants now.
Counted across the registry records on this site, refreshed daily.
Pregnant women in their third trimester (28 weeks or more) participating in this study are divided into two groups:
Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.
Exclusion Criteria:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.
Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.
Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.
A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Platelets
Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
ALT and AST (liver enzymes)
Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.
Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Contraindication
A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Informed consent
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
• Group A: patients with pre eclampsia, defined as follows: Patients with Systolic Blood Pressure greater or equal than140 mmHg and or Diastolic Blood Pressure greater or equal than 90 mmHg appearing after 20 weeks of gestation, WITH the presence of 24hour proteinuria greater or equal than300 mg per 24h, OR Patients with SBP greater or equal140 mmHg and or DBP greater or equal than 90 mmHg or 24hour proteinuria greater or equal than 300 mg per24h, WITH at least one of the following criteria Thrombocytopenia less than 100,000 permm³ Liver cytolysis greater than 2 times normal values Hemolytic anemia schistocytes, LDH more than 600 Serum creatinine mo 90 µmol per L and oliguria less or equal than500 ml per 24h excluding any functional or obstructive cause Acute pulmonary edema Subcapsular liver hematoma Neurological or sensory signs Eclampsia Severe intrauterine growth restriction
Diagnostic Test: Transcranial doppler ultrasound
Patients with SBP less than 140 mmHg and DBP less than 90 mmHg, with no clinical or biological abnormalities suggesting severe preeclampsia, and a negative 24hour proteinuria test if performed.
Diagnostic Test: Transcranial doppler ultrasound
This intervention involves performing Transcranial Doppler (TCD) ultrasound on pregnant women with preeclampsia in the third trimester. TCD is a non-invasive imaging technique used to assess cerebral blood flow velocity and detect potential cerebrovascular complications. The procedure is performed at the bedside, using standard clinical protocols. No contrast agents or medications are administered. This intervention is distinct from other ultrasound procedures as it specifically targets intracranial arteries and provides real-time hemodynamic data relevant to preeclampsia.
Also known as: TCD, Doppler ultrasound
Pulsatility index (IP) of the middle cerebral artery (MCA)
pulsatility index (PI) will be measured in the MCA using transcranial Doppler ultrasound in pregnant women with preeclampsia and in healthy pregnant women. The study aims to evaluate the diagnostic and prognostic value of this parameter: for women with preeclampsia, to identify severe forms of the disease, and for healthy pregnant women, to assess the risk of developing preeclampsia after the Doppler measurement.
Time frame: Measured during the third trimester
- pulsatility index (IP)measured in the posterior cerebral artery (PCA)
pulsatility index (PI) will be measured in the PCA using transcranial Doppler ultrasound in pregnant women with preeclampsia and in healthy pregnant women. The study aims to evaluate the diagnostic and prognostic value of this parameter: for women with preeclampsia, to identify severe forms of the disease, and for healthy pregnant women, to assess the risk of developing preeclampsia after the Doppler measurement.
Time frame: At study enrollement
cerebral blood flow index in the middle cerebral artery
cerebral blood flow index measured in the middle cerebral artery
Time frame: at study enrollement
cerebral blood flow index in the posterior cerebral artery
cerebral blood flow index measured in the posterior cerebral artery
Time frame: at study enrollement
correlation between middle cerebral artery pulsatiliy index and severityof preeclmapsia
association between middle cerebral artery pulsatiliy index values and clinical severity of preeclampsia
Time frame: at study enrollement
correlation between transcranial doppler parameters and blood pressure levels
association between doppler-derived cerebral hemodynamic parameters and systolic/diastolic blood pressure
Time frame: at study enrollement
neurological manifestations associatedwith abnormal transcranial doppler findings
Relationship between Doppler parameters and neurological manifestations such as visual disturbance ,headache , eclampsia ...
Time frame: During hospitalisation
Effect of antihypertensive treatement on transcranial dopller parameters
change in doppler parameters after initiation of antihypertensive therapy
Time frame: before treatement and 24 hours after treatement initiation
effect of magnesium sulfate on transcranial doppler parameters
change in doppler parameters following magnesiumbsulfae administration in severe preeclampsia
Time frame: before treatement and 24 hours after treatement initiation
Plan to share: No
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University Tunis El Manar