Preeclampsia (PE) is a pregnancy-related syndrome characterized by hypertension and end-organ dysfunction that affects about 2–8% of pregnancies [1]. It is worldwide a leading cause of maternal morbidity and mortality [2], and, accordingly, prediction and prevention of these maternal complications have been the main research focus. In addition, PE is also linked to neonatal complications mainly due to the associated placental insufficiency and prematurity, being responsible for 10% of stillbirths [3] and ranking first as a cause of iatrogenic prematurity [4].

In terms of pathophysiology, two entities can be distinguished, on one hand late-onset PE (developed after 34 weeks’ gestation) and on the other hand early-onset PE (developed before 34 week’s gestation), which is strongly associated with placental insufficiency and maternal systemic endothelial damage conferring the highest maternal and neonatal risks [5], [6], [7]. In addition, we can classify the disease by the presence of severe features. This severity is defined by laboratory and clinical parameters only from the maternal compartment. Moreover, most of the multi-parametric risk-scores models, such as Prediction of Risks in Early-onset Preeclampsia (PREP) and Preeclampsia Integrated Estimate of Risk (PIERS) have shown promise in the prediction of maternal but not neonatal outcomes [8], [9].

Fetal and maternal Doppler has been proposed for predicting neonatal adverse outcome, under the rationale that it may capture the intrauterine stress secondary to the maternal disease. Despite that, in the context of PE several studies have demonstrated that fetal Doppler indices did not accurately predict neonatal outcomes [10], [11], [12], [13], [14] and that the natural history of placental insufficiency is less predictable in women with PE [15]. Furthermore, Doppler ultrasound surveillance requires trained staff and advanced equipment, which may not be available in all settings.

In PE, the endothelial and placental dysfunction leads to increased levels of anti-angiogenic factors (like soluble fms-like tyrosine kinase-1 [s-Flt-1]) and decreased maternal levels of pro-angiogenics factors (like placental growth factor [PlGF]) [16], [17]. These biochemical markers seem to be helpful for the diagnosis of the disease and have emerged as reliable predictors of adverse perinatal outcomes in women with suspected PE [18], [19], [20], although it is not known its role in predicting neonatal complications in women with an established diagnosis of PE [21]. PlGF has shown also potential to predict the chances of perinatal survival in cases of early-onset fetal growth restriction (FGR) [22].

This study aims to assess the predictive value for adverse neonatal outcomes at admission of Doppler ultrasound, angiogenic factors and multi-parametric risk-score models in women with early-onset PE with severe features.