The predictive value of abnormal uteroplacental and fetal Doppler indices for adverse perinatal outcomes in hypertensive disorders of pregnancy: a systematic review and meta-analysis

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Objective To systematically evaluate the predictive value of abnormal uteroplacental and fetal Doppler indices for adverse perinatal outcomes in patients with hypertensive disorders of pregnancy (HDP), quantify the strength of association, and assess the certainty of evidence to optimize prenatal monitoring protocols. Methods Based on PRISMA guidelines, we searched Cochrane CENTRAL, PubMed, Embase, and SCIE for observational cohort studies published between January 2016 and March 2026. Included studies comprised singleton pregnant women with HDP who underwent uteroplacental and fetal Doppler assessment (e.g., UtA-PI, UA, MCA, or CPR) and reported perinatal outcomes. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS), and the certainty of evidence was graded using the GRADE framework. This study was registered with PROSPERO (CRD420261331863). Results Thirteen cohort studies involving 1,744 patients (25 independent datasets) were included. Meta-analysis revealed that HDP patients with abnormal uteroplacental and fetal Doppler indices had a significantly elevated risk of adverse perinatal outcomes (RR = 2.26, 95% CI: 1.93–2.64, P < 0.001). Subgroup analysis indicated that an abnormal Uterine Artery Pulsatility Index (UtA-PI) was a robust predictor (RR = 2.96, 95% CI: 2.26–3.89, P < 0.001, I 2 = 6%). An abnormal Cerebroplacental Ratio (CPR) also indicated an increased risk (RR = 1.92, 95% CI: 1.58–2.33, P < 0.001), though with substantial heterogeneity (I 2 = 73.0%). GRADE assessment graded the certainty of evidence as “Moderate” for the UtA-PI subgroup and “Low” for the CPR subgroup. Conclusion Abnormal uteroplacental and fetal Doppler indices, particularly UtA-PI and CPR, are strongly associated with adverse perinatal outcomes in HDP patients. UtA-PI serves as a stable mid-trimester risk-stratification tool, while CPR functions as a valuable supplementary index in the third trimester. We recommend a multi-parametric, sequential monitoring workflow for HDP management. Future research should prioritize establishing standardized, gestational-age-specific diagnostic thresholds for CPR to enhance clinical precision. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261331863 , identifier CRD420261331863.